Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
BMC Musculoskelet Disord. 2024 Jun 7;25(1):453. doi: 10.1186/s12891-024-07527-6.
Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations.
A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure.
Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis.
Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
创伤后腕关节炎是一种不可逆转且常进展的疾病。许多在日常实践中使用的手术治疗旨在缓解疼痛等症状并恢复功能。本系统评价的目的是评估创伤后腕关节炎患者最常见手术干预的患者报告和功能结果。这一综述可以帮助临床医生选择最佳治疗方案并管理患者的预期。
根据 PRISMA 指南，在 Pubmed、Embase 和 Cochrane 中进行了文献检索，检索了 1990 年至 2022 年 11 月期间发表的文章。研究方案已在 PROSPERO 数据库（CRD42017080427）中注册。纳入描述手术干预后 1 年以上患者报告结果（疼痛和手臂、肩部和手残疾度（DASH）评分）和功能结果（活动度（ROM）和握力）的研究。纳入的手术包括神经切断术、近排腕骨切除术、间置和全关节置换术以及腕中关节、腕桡关节和全关节融合术。汇总了术前和术后结果，并按挽救性手术进行了呈现。
纳入了 50 项研究的数据。除神经切断术外，所有手术的疼痛评分均改善。桡腕关节融合术后屈伸度减小，近排腕骨切除术后无明显变化，所有其他手术均改善。关节置换术、近排腕骨切除术和腕中关节融合术后 DASH 评分改善。间置关节成形术和部分关节融合术后握力改善。
本综述的证据不支持在该特定患者群体中进行神经切断术的适应证。在 SLAC/SNAC II 型患者中，仅基于近排腕骨切除术后桡腕关节的 FE ROM 更好，近排腕骨切除术可能优于腕中关节融合术。在桡骨远端骨折后发生的关节炎患者中，全腕关节置换术可能优于桡腕关节融合术，从桡腕关节活动度方面考虑。更统一的测量结果将提高对创伤后骨关节炎腕关节手术治疗效果的理解。
