Sullivan Mikaela H, Meaike Joshua J, Elhassan Bassem T, Kakar Sanjeev
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Massachusetts General Hospital, Massachusetts.
J Wrist Surg. 2024 Jul 17;14(4):366-373. doi: 10.1055/s-0044-1786188. eCollection 2025 Aug.
Salvage procedures for failed total wrist arthroplasty have variable results and limitations such as donor site morbidity, malunion, delayed or nonunion. We present a case of substantial bone loss after failed wrist arthroplasty and a surgical technique in which the distal ulna is transferred and intussuscepted to achieve union between the residual distal radius and metacarpals. A 48-year-old female with rheumatoid arthritis presented with wrist prosthetic joint infection 16 years after total wrist arthroplasty. With extensive bone loss following implant removal and multiple debridements, the remaining distal ulna was resected and intussuscepted between the residual radius and second and third metacarpals. The patient achieved incorporation of the graft at 12 weeks and fusion at 20 weeks, with resolution of pain and restoration of digit function at 2 years. Standard means of wrist arthrodesis utilizing iliac crest autograft and femoral head allograft may be limited to address substantial bone loss following total wrist implant removal. Intussusception has been utilized in the elbow, hip, and diaphysis to optimize graft-host bone contact and achieve union. While ulna-utilizing procedures have been described for oncologic and traumatic indications, to our knowledge, double intussusception has not been described for salvage procedures after failed wrist arthroplasty. Intussuscepting the distal ulna within the distal radius and metacarpals as an interpositional arthrodesis provides autologous graft, increased surface contact, and length restoration in cases of poor bone quality and significant bone loss following revision of a total wrist implant.
全腕关节置换失败后的挽救手术效果各异且存在局限性，如供区并发症、骨不连、延迟愈合或不愈合。我们报告一例腕关节置换失败后出现大量骨质缺损的病例，以及一种手术技术，即将尺骨远端转移并套叠植入，以实现残余桡骨远端与掌骨之间的愈合。
一名48岁类风湿关节炎女性患者，在全腕关节置换术后16年出现腕关节假体关节感染。在取出植入物并多次清创后出现广泛骨质缺损，切除剩余的尺骨远端并将其套叠植入残余桡骨与第二、第三掌骨之间。患者在12周时实现移植物融合，20周时实现关节融合，2年后疼痛缓解，手指功能恢复。
利用髂嵴自体骨移植和股骨头异体骨移植进行腕关节融合的标准方法，在处理全腕关节植入物取出后出现的大量骨质缺损时可能存在局限性。套叠技术已应用于肘部、髋部和骨干，以优化移植物与宿主骨的接触并实现愈合。虽然已有针对肿瘤和创伤适应证的利用尺骨的手术方法，但据我们所知，尚未有关于腕关节置换失败后挽救手术采用双重套叠的报道。
将尺骨远端套叠植入桡骨远端和掌骨之间作为间置关节融合术，可为全腕关节植入物翻修后骨质质量差和骨质大量缺损的病例提供自体移植物、增加表面接触并恢复长度。
