Cobb T K, Beckenbaugh R D
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
J Hand Surg Am. 1996 Nov;21(6):1011-21. doi: 10.1016/S0363-5023(96)80309-1.
Sixty-four consecutive biaxial total wrist arthroplasties performed in 52 patients between March 1983 and June 1988 were reviewed. Fifty-seven cases involving 45 patients were followed for a minimum of 5 years or until failure. Of the remaining 7 patients, 6 had died and 1 was lost to follow-up study. For the 46 intact implants in living patients, the mean follow-up period was 6.5 years (range, 5-9.9 years). The mean patient age at operation was 58 years. The underlying diagnosis was rheumatoid arthritis in 63 cases and juvenile rheumatoid arthritis in 1 case. At follow-up evaluation, pain was reported as none in 75%, mild in 19%, moderate in 3%, and severe in 3%. Patients rated their improvement as much better in 62%, better in 30%, some improvement in 4%, and worse in 4%. Range of motion at last follow-up averaged 36 degree extension, 29 degree flexion, 10 degree radial deviation, and 20 degree ulnar deviation. Grip strength improved from 4.1 kg preoperatively to 5.9 kg at last follow-up evaluation. Pain was likewise significantly improved at 1 year and 5 years. Failures occurred in 11 cases. The causes of failure were loosening of the distal implant in 8 cases and infection, dislocation, and progressive soft tissue imbalance in 1 case each. An abnormal resting stance and distal implant subsidence (> or = to 3 mm) at 1 year were associated with implant failure at final follow-up evaluation. The Kaplan-Meier probability of survival free of revision was 83% at last follow-up evaluation
回顾了1983年3月至1988年6月期间在52例患者中进行的64例连续双轴全腕关节置换术。对涉及45例患者的57例病例进行了至少5年的随访或直至失败。其余7例患者中，6例死亡，1例失访。对于存活患者中的46个完整植入物，平均随访期为6.5年（范围为5至9.9年）。患者手术时的平均年龄为58岁。潜在诊断为类风湿性关节炎63例，幼年类风湿性关节炎1例。在随访评估中，75%的患者报告无疼痛，19%为轻度疼痛，3%为中度疼痛，3%为重度疼痛。患者将自身改善情况评为“好多了”的占62%，“有所改善”的占30%，“有一些改善”的占4%，“更差”的占4%。最后随访时的活动范围平均为伸展36度、屈曲29度、桡侧偏斜10度和尺侧偏斜20度。握力从术前的4.1千克提高到最后随访评估时的5.9千克。疼痛在1年和5年时同样有显著改善。11例出现失败。失败原因包括8例远端植入物松动，各有1例感染、脱位和进行性软组织失衡。1年时异常的静息姿势和远端植入物下沉（≥3毫米）与最终随访评估时的植入物失败相关。最后随访评估时，无翻修的Kaplan-Meier生存率为83%
