リウマチ手関節に対する関節形成術の成績

Sauvé-Kapandji 法と橈骨手根骨部分固定を併用した Darrach 法との比較

抄録

This study was carried out to evaluate clinical results and radiological changes of the rheumatoid wrist treated by Sauvé-Kapandji procedure or Darrach procedure with radio-carpal limited fusion.
Fourteen wrist joints in 11 patients (2 males and 9 females) were selected in this study, with a mean follow-up period of 4 years and 4 months (range, 3 months-9 years and 4 months). Mean age at operation was 52.0 years old (range, 29-78 years old). Ten wrists had undergone Sauvé-Kapandji procedure, and 4 wrists had undergone Darrach procedure with radio-carpal limited fusion. All wrists had also undergone synovectomy. We compared with two group by postoperative clinical results and radiological changes.
Postoperative wrist pain disappeared in a 12 joints during 14 joints in both procedures. Postoperative synovitis recurred in joint with Sauvé-Kapandji procedure. There was no postoperative weakness of the grip power. Postoperative range of dorsal-palmar flexion and radial-ulnar flexion of the wrist joint decreased in both procedures, while that of supination-pronation of forearm were maintained fairly good. Carpal height ratio decreased after operation, while ulnar carpal shift ratio, radial rotation angle and palmar carpal subluxation ratio did not change. Both procedures released from wrist pain and would have an advantageous effect on the postoperative developmental deformity of the rheumatoid wrist.