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Proximale Karpektomie versus mediokarpale Teilarthrodese

Eine vergleichende Literaturanalyse

Proximal row carpectomy versus limited carpal fusion

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Summary

Proximal row carpectomy and limited carpal fusion are two therapeutic options for limited osteoarthritis of the wrist. On the basis of an analysis of 46 published studies with a total of 976 patients the clinical and radiological results of both procedures were compared. Subjective and functional outcome of both procedures were comparable. The limited wrist fusion maintained greater radial abduction than proximal carpectomy. Grip strength was greater and the complication rate was lower after proximal carpectomy. However, the secondary osteoarthritis rate seems to be higher after proximal carpectomy in comparison to limited wrist fusion. On the basis of this analysis proximal row carpectomy and limited wrist fusion are options for the treatment of limited osteoarthritis of the wrist with minimal differences in outcome. The therapeutic approach has to be determined individually.

Zusammenfassung

Die proximale Karpektomie und die mediokarpale Teilarthrodese weisen ein überschneidendes Indikationsspektrum auf. Im Rahmen einer Metaanalyse sollten die klinischen Ergebnisse beider Verfahren miteinander verglichen werden.

Basis der Analyse war eine medline-basierende Literaturrecherche. Anhand von definierten Ein- und Ausschlusskriterien wurden 46 Studien mit insgesamt 976 Patienten berücksichtigt und hinsichtlich klinischer und radiologischer Ergebnisse verglichen.

Beide Verfahren erzielten vergleichbare subjektive und objektive Ergebnisse. Während nach Teilarthrodese die Radial- und Ulnarabduktion größer war als nach Karpektomie war nach letzterem Verfahren die Grobkraft höher. Die Karpektomie wies eine vergleichsweise geringere Komplikationsrate auf. Die Teilarthrodese lässt langfristig eine geringere Arthroserate erwarten.

Auf Basis der Analyse war kein Verfahren dem anderen eindeutig überlegen. Die Therapieentscheidung muss aufgrund der spezifischen Erfordernisse des Patienten gestellt werden.

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Authors and Affiliations

  1. Sektion für Hand- und Mikrochirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany

    P. T. Wieloch,  A.-K. Martini &  M. Jung

  2. Klinik für Unfall-,Hand- und Wiederherstellungschirurgie, Johann Wolfgang Goethe Universität, Frankfurt, Germany

    W. Daecke

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  1. W. Daecke
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  2. P. T. Wieloch
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  3. A.-K. Martini
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  4. M. Jung
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Correspondence to M. Jung.

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Daecke, W., Wieloch, P.T., Martini, AK. et al. Proximale Karpektomie versus mediokarpale Teilarthrodese. Obere Extremität 1, 83–88 (2006). https://doi.org/10.1007/s11678-006-0006-1

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  • DOI: https://doi.org/10.1007/s11678-006-0006-1

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