Swanson A B, de Groot Swanson G, Maupin B K
Clin Orthop Relat Res. 1984 Jul-Aug(187):94-106.
The wrist joint is frequently impaired in rheumatoid, post-traumatic, and degenerative arthritis. Stable radiocarpal motion, even limited, can improve functional hand adaptations, especially if the proximal or distal joints are disabled. A flexible silicone intramedullary stemmed hinged implant was developed in 1967 to be used as an adjunct to resection arthroplasty of the radiocarpal joint while at the same time maintaining the radiocarpal relation and allowing wrist motion in all planes. The surgical technique includes proper contracture release, bone preparation, extensor tendon repair and balancing, and dorsal and palmar capsuloligamentous repair to allow only 60 degrees of total passive flexion/extension and 10 degrees radial/ulnar deviation. This procedure can be combined with ulnar head capping. Metal bone liners (grommets) may be used to protect the radiocarpal implant from sharp bone edges. From January 1970 to April 1983, 181 wrist implant procedures had been performed in 139 patients, most of whom had rheumatoid arthritis. Stable, pain-free functional motion was obtained in the majority of cases. Roentgenograms showed the implants to be well tolerated by bone. Complications were infrequent. Because this procedure does not require cementing or significant bone resection, revision or arthrodesis procedures are facilitated.
腕关节在类风湿性关节炎、创伤后关节炎和退行性关节炎中常受损害。稳定的桡腕关节活动，即使有限，也能改善手部功能适应性，尤其是在近端或远端关节功能丧失的情况下。1967年研发出一种柔性硅胶髓内带柄铰链式植入物，用作桡腕关节切除成形术的辅助手段，同时保持桡腕关节关系并允许腕关节在各个平面活动。手术技术包括适当的松解挛缩、骨准备、伸肌腱修复与平衡以及背侧和掌侧关节囊韧带修复，使总被动屈伸仅60度，桡尺偏仅10度。该手术可与尺骨头覆盖术联合进行。金属骨衬垫（索环）可用于保护桡腕关节植入物免受锐利骨边缘的损伤。1970年1月至1983年4月，139例患者共进行了181次腕关节植入手术，其中大多数患有类风湿性关节炎。大多数病例获得了稳定、无痛的功能性活动。X线片显示植入物在骨内耐受性良好。并发症很少见。由于该手术不需要骨水泥固定或大量骨切除，便于进行翻修或关节融合手术。
