Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎

Treatment of distal radiouinar joint dislocation and arthritis by Sauvé-Kapandji procedure

目的评价Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎的临床疗效。方法采用Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎12例。随访内容包括手术前后腕关节疼痛程度、腕关节活动度、握力以及术后患侧X线片情况。X线片检查观察桡尺远侧关节愈合及测量尺桡骨间距。Mayo腕关节评分法评价手术前、后腕关节功能恢复程度，DASH问卷调查表行手术前、后腕关节功能自我评价。结果术后随访9—32个月，平均16个月。术前腕关节疼痛值在负重后为[（39．0±17．0），x±s，下同]，术后疼痛值为（23．0±13．0）。尺桡偏活动度术前为（26．0±11．0）°，术后为（41．0±12．0）°；旋前、旋后活动度术前为（84．0±21．0）°，术后为（139．0±33．0）°。握力术前为（12．8±3．6）kg，术后为（24．0±7．4）kg。Mayo评分结果术前为（43．0±13．0），术后为（73．0±16．0），优3例，良4例，中3例，差2例。DASH值术前为（57．0±14．0），术后为（31．0±10．0）。X线片检查12例桡尺远侧关节及尺骨移植处全部愈合。结论Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎，疼痛明显减轻，旋转活动度和握力增加，功能明显改善。

Objective To evaluate the clinical effectiveness of Sauvé-Kapandji technique for the treatment of distal radioulnar joint dislocation and arthritis. Methods Twelve cases of distal radioulnar joint dislocation and arthritis were treated by Sauvé-Kapandji technique. All cases were followed up for 9-32 months, with an average of 16 months. Pre-and postoperative wrist pain degree, wrist range of motion, grip strength and X-rays of wrist were evaluated. According to X-rays, the distance between radius and ulna and radiological union were observed. Function of the wrist was evaluated by Mayo scores. Self-evaluations of postoperative wrist function were evaluated by DASH questionnaire. Results Wrist pain score was 39 ± 17 preoperatively and 23 ± 13 postoperatively. The preoperative range of motion of ulnar and radial deviation was 26° ± 11°, while the postoperative range was 41° ± 12°. Forearm rotation was 84° ± 21° preoperatively and 139° ± 33° postoperatively. The preoperative grip strength was 12.8 ＋ 3.6 kg, while postoperative was 24.0 ± 7.4 kg. The value of Mayo scores was 43 ± 13 preoperatively and 73 ± 16 postoperatively. Among the 12 cases, 3 were graded as excellent, 4 as good, 3 as fair and 2 as poor. The postoperative DASH score was 31 ± 10 as compared to the preoperative 57 ± 14. X-rays showed union of the distal radioulnar joint and ulnar bone graft in all cases. Conclusion Sauvé-Kapandji operation can relieve wrist pain, increase rotation and grip strength and improve wrist function in patients with distal radioulnar joint dislocation and arthritis.