滑膜切除结合Kapandji手术治疗腕类风湿性关节炎并伸肌腱断裂、尺骨小头脱位的效果

Synovectomy Combined with Kapandji Operation in the Treatment of Wrist Rheumatoid Arthritis with Extensor Tendon Rupture and Dislocation of the Ulnar Head

目的探讨腕滑膜切除术联合Sauve-Kapandji尺骨截骨术治疗腕关节类风湿性关节炎伴有伸肌腱自发性断裂,尺骨小头脱位的临床疗效。方法选取2017年6月~2019年6月我院骨科收治的10例腕关节类风湿性关节炎合并伸指肌腱自发性断裂及尺骨小头半脱位患者,采用腕关节背侧入路顺序行腕关节内滑膜切除术、Sauve-Kapandji手术,最后行伸指肌腱吻合或肌腱移位术,术后观察患者临床症状体征好转程度。结果所有患者术后尺骨小头脱位已矫正,腕关节背伸位石膏外固定,术后组织学病理均证实类风湿性关节炎滑膜增生改变。随访显示,患者患肢腕关节疼痛压痛肿胀好转,尺骨小头半脱位消失,前臂旋转功能良好,腕关节活动度随时间延长逐渐好转。结论滑膜切除术结合Sauve-Kapandji手术治疗腕关节类风湿性关节炎合并伸肌腱自发性断裂、尺骨小头半脱位效果良好,手术简便易行,能够同时处理腕关节内外类风湿病变,可以减轻患者局部症状,减缓疼痛,改善局部外观及功能,疗效满意。

Objective To explore the clinical effect of carpal synovectomy combined with Sauve-Kapandji ulnar osteotomy in the treatment of wrist rheumatoid arthritis with spontaneous rupture of extensor tendon and dislocation of ulnar head.Methods 10 patients with wrist rheumatoid arthritis combined with spontaneous rupture of the extensor tendon and subluxation of the ulnar head were selected from June 2017 to June 2019 in the orthopedics department of our hospital,and the wrist joints were performed sequentially through the dorsal wrist approach end synovectomy,Sauve-Kapandji operation,and finally an extensor tendon anastomosis or tendon shift.Observe the degree of improvement of the patient's clinical symptoms and signs after surgery.Results The dislocation of the ulnar head was corrected in all patients,and the wrist joint dorsiflexion was externally fixed with plaster.Postoperative histopathology confirmed the changes of synovial hyperplasia in rheumatoid arthritis.Follow-up showed that the patient's wrist joint pain,tenderness and swelling of the affected limb improved,the subluxation of the ulnar head disappeared,the forearm rotation function was good,and the wrist joint range of motion gradually improved with time.Conclusion synovectomy combined with Sauve-Kapandji operation for the treatment of rheumatoid arthritis of the wrist with spontaneous rupture of extensor tendon and subluxation of ulna capitulum is simple and feasible.It can simultaneously treat rheumatoid lesions inside and outside the wrist joint.It can obviously reduce the local symptoms,slow down the course of disease,improve the local appearance and function,and the effect is satisfactory.