Analysis Of Clinical Curative Effect On The Function Of Wrist Joint After Proximal Row Carpectomy

Objective: The proximal row carpectomy(Proximal Row Carpectomy PRC) is the removal of the wrist joint proximal scaphoid, lunate bone and triangular bone to the distal row of carpal bones in the capitate bone proximal pole and distal radius lunate fossa, composed of relatively new wrist. The operation is the first by the London Guy ’s hospital doctor Stamn in 1939 developed and adopted for treatment of old carpal joint injury and ischemic lunar bone necrosis. But because the operation destroys the normal anatomy of the wrist joint, muscle strength weakened patients after operation, capitate and the lunate fossa contact radius is not entirely reliable, so from the first case of operation has emerged, many disputes. In recent years, basic research on the biomechanics of the gradually increasing. But on the wrist joint function after proximal row carpectomy recovery, wrist anatomy change will cause new wrist injury, not many clinical reports. This research through to after proximal row carpectomy patients with wrist activity, grip strength and pain degree of the three main aspects of assessment of efficacy, explore after proximal row carpectomy on function of wrist joint effects, to provide reference and theoretical basis for clinical.Methods:1 The object of studyWe selectively review of 25 patients(20 patients from the Third Affiliated Hospital of Hebei Medical University, from 5 cases of Huabei Petroleum General Hospital, hospital operation time from 2008 May to 2014 December,The operation time from 3 months after injury to 2 and a half years), male 17 cases, female 8 cases, age 27-59 years, mean age 41 years, 9 cases of left wrist, wrist in 16 cases, the old after 16 cases of scaphoid perilunate dislocation, fracture of scaphoid nonunion of proximal necrosis in 9 cases. A total of 7 cases with multiple injuries, including 3 cases with craniocerebral trauma, 2 cases of thoraco abdominal injury, spinal fracture in 2 cases. The selected patients had had obvious wrist trauma history and history of pain; both the implementation of unilateral PCR surgery patients with wrist, the other side is the normal wrist, and all the patients without operation contraindication.2 Surgical methodsIn brachial plexus block anesthesia, the application of pneumatic tourniquet on the upper limb, wrist back, from the styloid process of ulna to the styloid process of the radius for a long transverse incision or "S" incision, the incision of skin, subcutaneous tissue, superficial dorsal attention, protection of the radial nerve dorsal cutaneous branch of the ulnar nerve, transverse cutting the dorsal carpal ligament along the incision, extensor hallucis longus tendon extensor retinaculum, the extensor carpi radialis tendon and the extensor pollicis longus tendon pulls to radial, refers to the total extension inherent tendon and tendon of extensor indicis retracted to the ulnar wrist capsule, exposing the back, open to joint capsule radiocarpal joint exposed and boat, month of bone, carefully clean after resection of scar tissue, in turn, triangular bone lunate and scaphoid, retention of pisiform bone. In addition, in the process of operation should pay attention to the protection of the deep branch of radial artery, capitate bone of proximal and distal radial articular surface. The three piece of wrist after resection, capitate and the lunate bone of distal radius concave form new wrist joint cavity, flushing, dorsal carpal ligament and wound suture. The postoperative function of wrist joint splint external fixation for 4 weeks, 4 weeks after the removal of gypsum, began active function training.3 Postoperative rehabilitationPostoperative routine to be non steroidal analgesic drug, is conducive to postoperative pain relief, if the pain worse, oral analgesic drug efficacy is not obvious, at any time to check the wound and limb blood supply. Support the wrist joint is fixed on the function application plaster after operation, the second day after operation to start moving the fingers, 4 weeks after the removal of gypsum began the function exercise, functional exercise should be to the wrist, finger flexion and extension activities and fine movements, such as using hand-held body-building ball, grip and so on, gradually increase the weight and the number of training, recovery of hand and wrist function.4 Curative effect evaluationAll the 30 patients were followed up in this group after sugery,wrist pain,grip strength,wrist joint activity index were recorded during follow-up.The pain visual analogue scale(VAS)to assess the degree of subjective pain.The patients postoperative grip strength compared with the contralateral grip strength analysis.Patients at the same time according to Cooney wrist evaluation method for function.5 Statistical treatmentUsing SPSS 18.0 statistical software,selecting patients with postoperative grip strength compared with the contralateral grip strength,using two independent sample mean t test,P<0.05,with statistical significance.Results:1 The general resultsIn 25 patients the average inpatient hospitalization time is 7-10 days, infection, hematoma, skin flap necrosis and other complications were not found operation incision suture removal, the average time is 14 days, reached a healing. Improved in all patients with wrist pain symptoms had different degree after operation.2 Curative effect evaluationAll 25 patients were followed up after the operation of the group, in 2months ~6 years follow-up time.According to the Cooney wrist score, the group of 25 patients, 16 cases were excellent, good in 5 cases, 4 cases, poor in 0 cases, the excellent and good rate was 84%.Selection of patients with postoperative grip and contralateral grip strength were compared using t test, P<0.05, and there was statistical significance.Wrist motion in flexion, dorsiflexion, ulnar and radial deviation 4 angles, retain activity probably accounted for between the contralateral 54%~75%, but the activity can meet the needs of daily life of patients,grip strength parameters with the percentage of the contralateral grip to express, make the individual effect is reduced, the results more in order to accurately, in the group of patients with ipsilateral to contralateral grip grip accounted for 76.7%. Is the pain for a patient with a standard to judge whether a satisfactory operation,20 cases were followed up without pain, 4 cases had mild pain and discomfort, but does not affect the daily life, 1 patients with moderate pain but can tolerate, no oral pain medication or because of pain and discomfort again operation. 25 patients at the last follow-up all the operation effect is satisfied or.Conclusions:1 Proximal row carpectomy retained activity of the wrist, grip strength was increased post operatively, but also effectively alleviate the wrist joint pain, operation safety, simple operation, the majority of patients after curative effect to express satisfaction.2 The proximal row carpectomy is an alternative to total wist fusion before and rescure operation,is an operative mode and method of the wrist function maximum retention.