Changes in radiocarpal loading characteristics after proximal row carpectomy

PURPOSE: To document the changes in wrist loading that occur after proximal row carpectomy in a cadaver model. METHODS: The normal radioulnar carpal pressure distributions of 7 cadaver wrists were measured using super-low-pressure-sensitive film. Proximal row carpectomies were performed and the loading characteristics re-evaluated. RESULTS: In the lunate fossa the contact area increased 37%, the average contact pressure increased 57%, and the location of the contact moved radially 5.5 mm. With wrist motion between 40 degrees of extension and 20 degrees of flexion the volar/dorsal excursion of the lunate fossa contact point increased by 108%. CONCLUSIONS: Significant changes in radiocarpal loading occur after proximal row carpectomy. The increased radiocarpal excursion with wrist motion may explain the low incidence of radiocapitate arthritis in patients who have had proximal row carpectomy.     

Early proximal row carpectomy after severe carpal trauma

Complex fracture dislocations of the wrist often result in post-traumatic arthrosis. In these cases, patients can experience severe pain and loss of function of the wrist and as a result many of them end up having a total arthrodesis. In trying to avoid the disadvantages of a total arthrodesis, alternative treatment strategies have been investigated, amongst which proximal row carpectomy (PRC). Basic conditions for a good outcome of PRC are an intact cartilage of the lunate fossa of the distal radius and an intact surface of the head of the capitate for the new radiocapitate joint (, schematic drawing post-PRC). Also, an intact (volar) radioscaphocapitate (RSC) ligament is necessary because it plays an essential role in stabilizing the new joint and preventing volar dislocation and ulnar translocation of the distal carpal row. Acute post-traumatic PRC can be indicated, but is rarely reported in literature. In this article, we present four patients whom we have treated with early PRC after severe trauma of the wrist. Three patients had a good outcome. In the patient with the bad outcome, the before-mentioned prerequisites were not met, which is discussed.     

近排腕骨切除术后桡腕关节的解剖学及生物力学变化

目的研究近排腕骨切除术后新的桡腕-桡头关节的解剖学特点及生物力学变化，增强临床对这一术式的理解。方法6只福尔马林固定的尸体腕标本，模拟近排腕骨切除术后观测头状骨近端关节面；纵性剖开头状骨及月骨，描拓桡月关节和桡头关节的匹配曲线；选用6只新鲜标本牙托粉包埋后，用压敏片在双轴液压材料测试系统上测试正常和术后桡腕关节的接触面积和压力变化。数据进行统计学处理。结果正常桡月关节匹配曲线良好，腕骨切除术后头状骨近端关节面有4个子关节面，和桡骨远端的桡月窝匹配性差。腕中立位下，正常的平均腕单位面积负荷为（22．9±4．3）N／cm^2。近排腕骨切除术后为（136．4±30．7）N／cm。（P〈0．05）。结论近排腕骨切除术后形成的新桡腕关节-桡头关节其解剖学和生物力学都明显异常。     

近排腕骨切除加骨间掌、背侧神经切断治疗退行性腕关节炎

目的评价近排腕骨切除加骨间掌、背侧神经切断术治疗退行性腕关节炎的疗效。方法1996年3月-2002年12月,对30例退行性腕关节炎行近排腕骨切除和腕部骨间掌、背侧神经切断术。术后测量腕关节的活动度、握力和疼痛程度,腕关节功能评定采用Krimmer评分法。术后拍摄腕关节X线正侧位片,了解腕关节骨性改变情况。结果术后随访8~66个月。腕关节屈伸活动度平均为70°(健侧为126°),尺桡偏平均为36°(健侧为66°);握力为25kg(健侧为46kg);疼痛值为32(术前为73);腕关节功能评分为70。腕关节X线片示,术后3例腕关节形成关节炎。结论近排腕骨切除加骨间掌侧及背侧神经切断可保留腕关节部分功能,减轻腕关节疼痛,是治疗退行性腕关节炎的有效手段。     

Proximal row carpectomy

Proximal row carpectomy has become an increasingly popular procedure in the treatment of arthritic disease of the proximal carpal row. Preoperative arthritis at the capitolunate articulation seems to be a relative contraindication. Care should be taken surgically to preserve all capsular ligaments. The majority of patients experience satisfactory pain relief, functional wrist motion, and effective grip strength.     

Long-term assessment of proximal row carpectomy for chronic perilunate dislocations

Twelve patients with chronic stage III or stage IV perilunate dislocations were managed over the past 7 years by proximal row carpectomy. All dislocations were untreated or incompletely reduced for a minimum of 8 weeks after injury. The mean time from injury to definitive treatment was 15 weeks (range, 8 weeks to 6 months). Surgical management was inclusive of a dual dorsal and volar approach. Median nerve decompression, lunate excision, and capsuloligament repair was performed volarly and scaphoid and triquetrum carpectomy was accomplished dorsally. Temporary radio capitate K-wire fixation during early soft tissue healing was uniformly performed. All patients were evaluated at an average postoperative duration of 40 months (range, 28 months to 7 years). Marked relief of wrist pain and median nerve dysesthesias was routinely achieved. Effective wrist range of motion and grip strength were restored. Untreated stage III and IV chronic perilunate dislocation treated by proximal row carpectomy eliminates pain and restores function to a severely injured wrist.     

近排腕骨切除术中期疗效

目的 评估近排腕骨切除术3年以上的手术疗效.方法 对1992-2004年在我科进行近排腕骨切除3年以上的19例患者进行随访(随访时间为3～10年,平均6.7年),观察术后腕关节的影像学资料、握力和腕关节活动度.结果 19例中有16例术后随访时无疼痛,3例轻度疼痛.术后发生桡腕关节退变者8例.腕关节平均活动度:屈伸(72±17)°,尺桡偏(39±11)°,分别为健侧的63%和45%.腕部握力平均为(20±11)kg,为健侧的77%.结论 近排腕骨切除术的中期疗效稳定.     

Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy

PURPOSE: Proximal row carpectomy (PRC) can be an effective treatment option for arthritis of the wrist, but the operation is contraindicated when there is substantial arthritis of the capitate head. We describe a new technique that involves resurfacing of the capitate when there is chondrosis by using osteochondral grafts harvested from the resected carpal bones. The purpose of this study was to assess the outcomes of patients who had osteochondral resurfacing in the setting of PRC (OCRPRC) for capitate chondrosis and to determine how they compare with published results of conventional PRC. METHODS: Patients having PRC who had grade II to IV (Modified Outerbridge Scale) capitate chondrosis underwent osteochondral resurfacing of the capitate. Preoperative and postoperative pain level, employment status, range of motion (ROM), grip strength, and Mayo wrist scores were assessed, and Student's t-test was used. Postoperative Disability of the Arm, Shoulder and Hand (DASH) scores were also calculated. RESULTS: Eight patients with an average age of 53 years were followed up for 18 months. Preoperatively, 7 patients described their pain as moderate to severe; postoperatively, 7 patients described their pain as mild to no pain. Preoperative arc of motion was 84 degrees (74% of the contralateral side); postoperative arc of motion was 75 degrees (66% of the contralateral side). Preoperative grip strength was 29 kg, or 62% of the contralateral side; postoperative grip strength was 34 kg, or 71% of the contralateral side. Preoperative Mayo wrist score was 51 ("poor"); postoperative Mayo wrist score was 68 ("fair"). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Magnetic resonance imaging at 21 months postoperatively showed graft incorporation. No complications were encountered. CONCLUSIONS: Our results with osteochondral resurfacing compare favorably with the published results of conventional PRC in terms of pain relief, employment status, ROM, and grip strength.     

Subchondral bone mineral density patterns representing the loading history of the wrist joint after a proximal row carpectomy

To evaluate force transmission patterns in vivo of patients with complaints of wrist instability requiring a proximal row carpectomy, bone mineral density (BMD) patterns of the wrist were established using computed tomography absorptiometry. Normal wrists show a BMD pattern in which the scaphoid fossa and lunate fossa of the distal radius contain a center of force transmission. Wrists with pathology of the proximal carpal row or distal radius show a shift of BMD towards the dorsal edge and the styloid process of the scaphoid fossa. After a proximal row carpectomy, the BMD of the scaphoid fossa decreases, and a BMD center is formed in the center of the lunate fossa, demonstrating that the force transmission is concentrated in its center.     

近排腕骨切除术后对腕关节生物力学影响的实验研究

目的测定正常腕关节和近排腕骨切除术后腕关节的活动范围和生物力学变化,探讨近排腕骨切除术后腕关节功能丧失和并发症出现的机制。方法选用16例新鲜腕关节标本,通过CSS-44020系列生物力学试验机(中国长春试验机研究所制造),牵引腕关节于被动掌屈、背伸、尺偏和桡偏位,测量正常腕关节和近排腕骨切除术后腕关节的活动范围。然后在腕关节内放置压敏片,于中立位对腕关节施压,分析压敏片上相关信息。结果正常腕关节标本掌屈(74.2°±4.9°,-x±s,下同)、背伸63.3°±3.6°、尺偏36.8°±2.6°、桡偏20.2°±3.4°。近排腕骨切除后掌屈48.1°±5.6°、背伸43.6°±4.6°、尺偏21.0°±4.3°、桡偏10.3°±4.1°。正常腕关节的受力面积平均为(640.57±23.15)mm2,近排腕骨摘除组为(81.26±2.38)mm2。正常腕关节负荷压力为(27.68±0.73)N/cm2,近排腕骨切除组为(169.81±2.27)N/cm2。结论近排腕骨切除术后腕关节活动范围丧失较大,其应力负荷的增加明显超出了正常腕关节所承受的压力负荷,使腕关节功能丧失较多并容易在术后产生腕关节退行性关节炎等并发症。     

Proximal row carpectomy in advanced Kienbock's disease

This retrospective study assessed the outcomes of 21 patients (16 male and 5 female, mean age 39 years) with advanced Kienbock's disease treated by resection of the proximal carpal row. They were clinically reviewed. The mean follow-up was 67 months, with all but two patients having had a follow-up of 2 years. No or mild pain was being experienced by 13 patients, moderate pain by 3 and severe pain by 5. Grip strength increased from 19 kg pre-operatively to 26 kg postoperatively (or 65% of the normal contralateral side). There was a slight increase of mobility. The DASH score was 22 points (range 0-78) and the Patient Rated Wrist Score (PRWS) was 30 points (range 0-84). Two patients developed Complex Regional Pain Syndrome which was ongoing at the time of review and one developed a superficial wound infection. Proximal carpal row resection arthroplasty gave satisfactory results in patients with advanced Kienbock's disease.