Tran Van F, Obry C, Fardellone P, Decoopman M, Vives P
Service de Chirurgie Orthopédique et Traumatologie, Hôpital Universitaire d'Amiens.
Ann Chir Main Memb Super. 1993;12(2):115-22; discussion 123.
The authors present a series of 25 cases of rheumatoid wrists, operated by tendon and intra-carpal synovectomy, accompanied by an arthrodesis of the lower ulnar articulation following a metaphyseal resection of the lower extremity of the ulnar according to Sauve and Kapandji. This series is "young", as the mean follow-up is 2 years. It involves 25 patients, including 4 operated on both wrists. This series has the advantage of being coherent as all the operations were performed by the same surgeon. The results concerning pain are good; 87% of the wrists were painless or only periodically painful, and 88% of the patients say they are well or very much better. This operation offers the satisfying aspect of prevention; an absence of pain in the wrist when inflamed and the absence of complications such as ruptured tendons. The study of the range of motion shows a global loss of 9% in the sagittal plane and a significant reduction in the score for motion in palmar flexion. The radiological signs of deterioration of carpitis are not stopped despite the operation but it does seem to be slowed down after intra-carpal synovectomy. Ulnar sliding has been carefully studied. We observe that a further sliding is more obvious in the Larsen 2 phase than in the Larsen 3 phase. This sliding is very slight. The comparison between the different series shows that operation protects the wrist from ulnar sliding more than ulnar head resections.
作者报告了25例类风湿性腕关节病例，均接受了肌腱和腕内滑膜切除术，并根据Sauve和Kapandji法在尺骨远端干骺端切除术后进行了下尺关节融合术。该系列病例“年轻”，平均随访时间为2年。涉及25例患者，其中4例为双侧腕关节手术。该系列的优点是连贯性好，因为所有手术均由同一位外科医生完成。疼痛方面的结果良好；87%的腕关节无痛或仅偶尔疼痛，88%的患者表示状况良好或改善明显。该手术具有令人满意的预防效果；腕关节发炎时无疼痛，且无肌腱断裂等并发症。活动范围研究显示矢状面整体活动度丧失9%，掌屈活动评分显著降低。尽管进行了手术，腕关节炎的放射学恶化征象并未停止，但腕内滑膜切除术后似乎有所减缓。对尺骨滑动进行了仔细研究。我们观察到，在Larsen 2期，进一步的滑动比Larsen 3期更明显。这种滑动非常轻微。不同系列病例的比较表明，该手术比尺骨头切除术更能保护腕关节免于尺骨滑动。
