proximal carpal resection

Due to the yearly and continuous literature reports, especially the comparative study of the clinical efficacy of some carpal fusion, the proximal row of carpalectomy (PRC) has got rid of some doubts since its introduction, and it has become clinically recognized and Partial carpal fusion has become the main treatment for advanced wrist degeneration. The technology is maturing, but there are still some points that have not been unified, such as the details of carpal bone resection, biomechanical studies and clinical efficacy, and whether there is degeneration of the distal tibia and the proximal end of the humerus. This surgery or how to adjust the surgery and so on. Treatment of diseases: osteoarthritis, rheumatoid arthritis, kidney damage in the elderly Indication It is suitable for the ischemic necrosis of stage IV of the lunate bone, the near-polar necrosis of the scaphoid fracture, the old (more than 3 months), the dislocation around the moon or the fracture and dislocation around the moon. The severe reduction of the articular surface of the tibia or the distal radius of the humerus is prohibited. Due to the stability of the overall surgical effect and the improvement of the technology, the indications of PRC have also undergone significant changes. It can now be used for wrist degeneration caused by any cause, among which the more common is the nonunion of the late hand scaphoid and the collapse of the wrist. The degeneration of the articular surface of the distal humerus or the proximal end of the humerus is not a contraindication. If mild, the efficacy of standard PRC is unchanged. If it is severe, it can be solved by traction resection, intra-articular interposition and proximal osteotomy. These techniques are relatively mature. There are reports that PRC is not effective for patients with rheumatoid arthritis. The authors believe that the cause is the progression of the primary disease, not surgery. The author does not support this procedure for patients younger than 35 years of age. Obviously, like other joints, the high activity of young patients always discounts the efficacy of any joint surgery. Recently, the authors have used arthroscopic examinations on the ankle joints and wrist joints to evaluate the articular surface and decide whether or not to perform this operation or how to take measures during the operation. Contraindications 1. The infection after the local injury has not been eliminated. 2. Injury refers to the passive flexion and extension of each joint. Preoperative preparation 1. Edema and inflammation of the limbs and wards, even if mild, should be actively treated, so that it completely disappears after 2 to 3 months of surgery. 2. Local large and hard scars should be removed first and the flaps should be repaired to ensure a good blood supply and a soft loose tissue bed around the tendons. 3. Before the tendon is sutured, the joint stiffness of the dominant tendon should be treated first, and the physical therapy and active and passive exercise should be given to restore the greater activity, so that the effect of the tendon suture can be operated and received. 4. The suture material should be selected from the varieties with small reaction, large pulling force and smooth surface. Generally, soft stainless steel wire with a diameter of 0.25 to 0.30 mm is preferred, and is mostly used for drawing steel wire stitching. Tendons with small or small diameters can be sutured with Nilon monofilament. Filament thread suture has a certain degree of tissue reaction, mostly used for Bunnell burial suture, but the silk thread must be able to withstand 1 to 1.5 kg of tensile force. 5. Prepare a slender straight round needle for suturing the tendon. Surgical procedure The X-ray positive and lateral slices have an anatomy of the wrist. A curved incision of about 6 cm in length was made on the dorsal side of the wrist joint centering on the wrist joint. Exposed extensor tendon support band. The extensor tendon support band was cut between the third and fourth compartments, and the extensor tendon was pulled to the ulnar side, the long extensor tendon of the thumb and the long wrist extensor and the short extensor tendon were pulled to the temporal side to expose the dorsal joint capsule. The dorsal joint capsule was cut transversely, and its attachment to the proximal carpal bone was released, revealing the proximal carpal bone. The threaded steel needle is sequentially screwed into the triangular bone, the scaphoid bone and the lunate bone, together with the styloid process of the humerus. Clean the wound. The dorsal joint capsule is sutured. Filming the flat piece, if the proximal end of the head bone is not completely located in the distal humerus of the humerus, it needs to be reset and fixed with a Kirschner wire. Loosen the tourniquet, stop bleeding, and determine the sutured extensor tendon support band after no active bleeding. Close the incision. complication The main cause of failure in PRC surgery is recurrence of pain, and the literature shows between 0% and 20%. If the hornbone and the sacral styloid process are found to collide during the operation, the sacral styloid process is performed. However, there are still a small number of patients undergoing secondary humeral stem resection after surgery, apparently relying solely on intraoperative visual observation for lack of reliability, but there is currently no accurate study of whether or not to perform the sacral styloid resection. For the postoperative degenerative joint of the taro joint, full wrist fusion is feasible, but some authors only perform tibial arthrodesis. Wrist joint replacement technology is progressing slowly, but as a promising technology, it may replace PRC in the future and become the main surgical method for the late degeneration of the wrist.

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