Teilfusionen am Handgelenk – eine Alternative zur Totalarthrodese

Abstract

Despite the important observations that have been made concerning biomechanics and function of the wrist joint in recent years, the surgeon is still confronted with a huge number of delayed posttraumatic disorders of this joint. In the past, total wrist fusion was the leading salvage procedure, whereas today several salvage procedures are available to solve these problems. Partial wrist fusions are supposed to stabilize the carpus, immobilize destroyed articulating surfaces while allowing motion in the unharmed parts of the wrist. Acknowledging pathobiomechanical laws, they have been used for a growing number of indications with a large benefit. The patients profit of better functional results than can be observed in patients with total arthrodesis of the wrist. Furthermore, partial wrist fusion provides a more stable situation and the absence of pain for a longer period of time. However, further studies evaluating the clinical outcome of these salvage procedures are necessary and to be expected in the near future.

Radiolun�re und radioskapholun�re Arthrodese bei chronischer Polyarthritis

“…Grundlage für deren differenzierte Anwendung sind neben der Vertrautheit mit der Operationstechnik genaue Kenntnisse der Anatomie, Biomechanik und Pathobiomechanik des Handgelenkes und die exakte Analyse eingetretener und zu erwartender Veränderungen [12,14]. Die Durchführung einer radiolunären Arthrodese ist bei Ulnardrift des Karpus bei der rheumatischen Arthritis zu empfehlen [12].…”

Po laivelio pseudoartrozės įvykusio riešo kolapso eiga ir gydymas

“…A.Berger siûlo trikampio formos kapsulës pjûvá pagal raiðèiø vidurinës grupës skaidulø kryptá [16]. Kai kurie autoriai iðpjauna dalá tarpkaulinio nugarinio nervo [17] [20]. Rieðo vidurinio sànario artrodezae su proksimalinës rieðakauliø eilës paðalinimu lygina J. D. Wyrick ir P. J. Strern [14], L. Nagy ir U. Büchler [21].…”

“…Esant treèiai potrauminio kolapso artrozës stadijai, rieðo vidurinio sànario artrodezës alternatyva gali bûti tik rieðo artrodezë. Deja, rieðo artrodezë visiðkai panaikina judesius, bet ne visada paðalina skausmus [17,21]. Taigi gydant antros ir treèios stadijos artrozae pirmenybë turi bûti teikiama rieðo vidurinio sànario artrodezei (7, 8 pav.)…”

Riešo vidurinio sąnario artrodezė gydant laivelio pseudoartrozę

“…Vëlyvieji rezultatai visiðkai atitiko kitø autoriø -R. Meier ir kt. [11], M. Sauerbier ir kt. [12], H. G. Tun-7 pav.…”