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首页> 外文期刊>Atlas of the hand clinics >Radiolunate and Radioscapholunate Fusion for Rheumatoid Arthritis of the Wrist
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Radiolunate and Radioscapholunate Fusion for Rheumatoid Arthritis of the Wrist

机译：Radiolunate和Radioscapholunate融合治疗手腕类风湿关节炎

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摘要

Between 75% and 95% of patients afflicted with rheumatoid arthritis will have involvement of the wrist joint [1,2]. Rheumatoid arthritis of the wrist may cause pain and instability that severely limits the functional status of the hand regardless of the status of the fingers [3]. Deformity of the wrist reduces motion, compromises grip strength, and increases the risk of tendon rupture. In addition, deformity of the wrist is a major contributing cause of finger deformities.Progressive synovitis, enzymatic degradation of cartilage, and pannus invasion ultimately lead to recognized patterns of deformity in rheumatoid arthritis. At the wrist, the disease usually begins in the radiocarpal, radioulnar, and ulnocarpal joints, initially sparing the midcarpal joint. Synovial proliferation distends capsular and ligamentous structures that normally maintain carpal alignment. As no tendons insert on the carpal bones, the wrist is particularly vulnerable to collapse subsequent to ligament attenuation or alteration in the direction of overlying tendon pull [4]. Synovitis stretches the ulnocarpal ligamentous complex resulting in dorsal dislocation of the distal ulna, volar subluxation of the extensor carpi ulnaris, and volar subluxation of the ulnar carpus, creating relative supination of the carpus to the forearm [5]. Attenuation of the radiocarpal ligaments results in rotatory instability of the scaphoid, which assumes a volar flexed posture. In addition, there is radial rotation of the carpus, loss of carpal height, and ulnar translation of the carpus. This translation occurs as the scapholunate complex drifts down the slope of the distal radius in an ulnar and volar direction. Attenuated ligaments are unable to restrain the carpus and the triangular fibrocartilage complex (TFCC) is unable to block its migration.
机译：在类风湿关节炎患者中，有75％至95％会累及腕关节[1,2]。手腕的类风湿关节炎可能会导致疼痛和不稳定，从而严重限制了手的功能状态，而与手指的状态无关[3]。腕部畸形会减少运动，损害握力，并增加腱断裂的风险。此外，手腕的畸形是手指畸形的主要原因。渐进性滑膜炎，软骨的酶促降解和pan的侵袭最终导致类风湿性关节炎的畸形。在腕部，该病通常始于the腕，radio尺和尺腕关节，最初不累及中腕关节。滑膜增生会扩张通常保持腕骨对齐的囊膜和韧带结构。由于没有肌腱插入腕骨，因此腕部特别容易因韧带减弱或沿肌腱牵拉方向的改变而塌陷[4]。滑膜炎牵拉尺腕韧带复合体，导致尺骨远端背侧脱位，尺侧腕腕掌侧半脱位和尺腕腕掌半脱位，从而使腕掌相对前臂发生旋后[5]。 radio腕韧带的衰减会导致舟骨的旋转不稳定性，这会导致手掌屈曲。另外，腕骨有径向旋转，腕骨高度降低，腕骨尺骨平移。当肩cap骨复合物在尺骨和掌骨方向上沿远端radius骨的斜度向下漂移时，发生这种平移。韧带减弱无法束缚腕骨，三角形纤维软骨复合体（TFCC）无法阻止其迁移。

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