wrist fusion

The wrist joint includes three rows of joints, that is, joints between the tibia and the proximal carpal bone, between the proximal row and the distal carpal bone, and between the distal carpal bone and the base of the metacarpal. Commonly used wrist joint tuberculosis involves all joints, and all three rows of joints should be included in the fusion. However, if the comminuted fracture of the lower end of the humerus, the arthritis caused by the scaphoid fracture, etc., the lesion only affects the proximal 1 to 2 rows of joints, only limited fusion of the row of joints. This will preserve some of the movements of the wrist joint. Intraoperative joints that do not need to be fused should be protected from injury. Treatment of diseases: carpal tunnel syndrome carpal tunnel syndrome Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Surgical procedure 1. Position: supine position, upper limb abduction, pronation before placing on the small table next to the operating table. 2. Incision, revealed: median longitudinal incision or s-shaped incision of the wrist, from the 5 cm of the wrist of the ulna to the base of the third metacarpal. Open the dorsal ligament of the wrist, and pull the longissimus dorsi and the total tendon of the extension finger to the sides to see the wrist joint capsule (see the posterior side of the wrist joint). 3. Excision of the cartilage surface: longitudinally incision of the periosteum at the lower end of the humerus, and subperiosteal stripping. The joint capsule of the wrist joint is removed, and the joint is composed of bone. The cartilage surface of the ankle, wrist, and metacarpal bone is removed, and the lesion is completely removed. The carpal bones are small and numerous, and all around them are articular surfaces. The cartilage surface of severe tuberculosis patients floats on the bone and is easier to remove. However, in diseases such as damaging arthritis, the cartilage surface is basically normal, and the chiseling is time consuming, and the corresponding round chisel can be used to puncture carefully, so as not to affect the healing. At the same time, due to the limitations of the surgical field, the operation must be careful to prevent damage to the soft tissue on the volar side. The lower joints should be preserved. If the lesions are stiff, a distal ulnar resection should be performed (see distal ulnar resection) to restore the rotation of the forearm. 4. Extra-articular fusion: the wrist is placed in the functional position (dorsal dorsiflexion 20 ° ~ 25 °, the third metacarpal and humerus on the same axis), by the person to maintain the position. On the midline of the carpal bone and the base of the 2nd to 4th metacarpal, a bone groove 1.5cm wide and 0.5cm deep was drilled. In the lower part of the humerus, a bone piece 6 cm long and the same width as the bone groove was taken, and the distal end was slid into the implant. The joint space and the gap between the bone and the bone graft are tightly filled with broken bone pieces. After suturing the ligament of the wrist, the bone graft can be stably fixed and the skin is finally sutured.

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