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Die Entfernung der proximalen Handwurzelreihe als bewegungserhaltender Eingriff beim karpalen Kollaps

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Zusammenfassung

Die Entfernung der proximalen Handwurzelreihe ist ein bewegungserhaltender Eingriff zur Behandlung des karpalen Kollaps wobei ein arthrosefreies Gelenk entsteht. Ziel der Arbeit war die retrospektive Untersuchung der funktionellen Ergebnisse dieser Operation. Die Indikationen waren Handgelenkarthrosen nach Skaphoidpseudarthrose, skapholunärer Bandruptur, Lunatumluxationen und -luxationsfrakturen und distaler Radiusfraktur, sowie die Mondbeinnekrose Stadium III. Ausgewertet wurden Beweglichkeit und Kraft, die Schmerzreduktion und der DASH-Wert, sowie der Mayo- und der Krimmer-Handgelenkscore; 33 Patienten wurden im Durchschnittsalter von 41,2 Jahren untersucht. Die Nachuntersuchungzeit betrug 36 (10–108) Monate. Die Extension/Flexion betrug 70°, die Radial-/Ulnarduktion betrug 33°. Die Handkraft betrug 54% der Gegenseite; 4 Patienten entwickelten eine Arthrose im neuen Gelenk. Der Mayo- bzw. der Krimmer-Wrist-Score ergaben 66 bzw. 69 Punkte. Die Belastungsbeschwerden waren um 55% gemindert. Der DASH-Wert lag bei 27,8 Punkten. Die Entfernung der proximalen Handwurzelreihe ist ein technisch relativ einfacher, komplikationsarmer Eingriff mit guter Restbeweglichkeit aber einem gewissen Kraftverlust.

Abstract

Proximal row carpectomy (PRC) is a motion-sparing procedure for the treatment of advanced carpal collapse. The goal of the operation is the creation of a new joint between the capitate and the radius. The purpose of this retrospective study was the evaluation of the functional outcome after PRC.

>The evaluation included range of motion, grip strength, and pain reduction. The DASH questionnaire was used to estimate restrictions of the activities of daily living (ADL). Results were ranked with the Mayo and Krimmer wrist scores.

Thirty-three patients with a mean age of 41.2 years were evaluated after 36 months. Flexion/extension was 70° and radial and ulnar deviation was 33°. The grip strength was 54% of the unaffected side. The results of Mayo and Krimmer wrist scores were 66 and 69 points. The mean DASH score was 27.8. Eighty-seven percent of the patients reported that pain was better than preoperatively.

Resection of the proximal carpal row is technically an easy surgical procedure. It preserves good functional range of motion and provides good pain relief, but low grip strength.

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Authors and Affiliations

  1. Klinik für Plastische, Ästhetische und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Offenbach, Offenbach

    M. Tränkle

  2. Klinik für Hand Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen, Universität, , Heidelberg

    M. Sauerbier, K. Blum, B. Bickert & G. Germann

  3. Klinik für Plastische, Ästhetische und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach

    M. Tränkle

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  1. M. Tränkle
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  2. M. Sauerbier
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  4. B. Bickert
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  5. G. Germann
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Correspondence to M. Tränkle.

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Tränkle, M., Sauerbier, M., Blum, K. et al. Die Entfernung der proximalen Handwurzelreihe als bewegungserhaltender Eingriff beim karpalen Kollaps. Unfallchirurg 106, 1010–1015 (2003). https://doi.org/10.1007/s00113-003-0670-1

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  • DOI: https://doi.org/10.1007/s00113-003-0670-1

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