- 期刊
Serious Complication of Sauve-Kapandji Procedure for Distal Radioulnar Joint Reconstruction-A Case Report and Literature Reviews
Sauve-Kapandji 手術式用於重建遠端橈尺關節時嚴重之併發症－病例報告及文獻回顧
摘要
遠端橈尺關節及三角纖維軟骨韌帶對於前臂、手腕及手部功能的維護扮演一個重要且獨特的角色。這個部位受傷時常常不是不易診斷就是難以重建治療。此部位受傷的病人，常常引起尺側腕關節疼痛、手掌握力的減弱或前臂迴旋轉動的限制。目前廣為大家討論及使用的手術方式是Sauve-Kapandji手術法。它包括了遠端橈尺關節融合術及新建立一個尺骨偽關節。藉由此法，多數病人的遠端橈尺關節疼痛可以得到改善。前臂的迥旋轉動也可以保留。不過術後的尺骨殘段不穩定的現象仍是一個我們關注的問題。本篇文章以一個遠端橈尺關節傷害的個案，在其他醫院先後進行四次手術，包括Sauve-Kapandji手術，術後不僅有尺骨殘段不穩定的現象，更由於骨問膜(interosseou, membrane)疤痕組織導致其左前臂外旋更加困難，經放鬆骨問膜結疤，手術固定尺骨殘段，及移除造成尺側伸腕肌肌腱炎的骨片，術後三個月追蹤顯然示病人左前臂外旋由10度增加到60度。握力也由原來對側的百分之二十五增加到百分之八十。雖然Sauve-Kapandji手術可適合用於頑固性橈尺骨關節炎，但良好的手術技巧及術後的復健更重要，以避免疤痕形成。在治療此併發症時，同時施行肌腱固定術，以避免尺骨不穩定的問題。另外也回顧一些有關Sauve-Kapandji手術式的文獻報告。
關鍵字
無資料並列摘要
Several methods of surgical treatment for distal radioulnar joint (DRUJ) disorders have been proposed. Recently, there has been an interest in the Sauve-Kapandji procedure as a treatment for severe DRUJ disorders. In 1936, Sauve and Kapandji described this procedure that included an arthrodesis of the distal radioulnar joint and a pseuoarthrosis of the ulna, proximal to the fusion. Theoretically, pain is eliminated by the arthrodesis; and pronation and supination are regained by the creation of a pseudoarthrosis. In this article, we present a patient with distal radioulnar joint injury who bad previously received four surgical procedures at other hospitals, including the Sauve-Kapandji procedure. Unfortunately, severe limitation of forearm supination, which was only 10° and grip weakness were noted. Forearm pronation contracture due to interosseous membrane contracture was suspected. Surgical procedures including (1) release of scarred interosseous membrane and pronator quadratus muscle for forearm rotation and (2) extensor carpi ulnaris (ECU) tenodesis for proximal ulnar instability, (3) removal of bone chip at ECU insertion for tendinitis were performed. Postoperative 3 months follow-up revealed that the grip strength increased to 32 kg from 10 kg before surgery and the range of forearm supination regained 50° from 10° before surgery. Although Sauve-Kapaudji procedure is indicated for intractable distal radioulnar joint disorder, good surgical technique, minimal manipulation of soft tissue and postoperative rehabilitation are important to prevent such a serious complication. On the other hand, after release of interosseous membrane contracture, extensor carpi ulnaric tenodesis bad better be used for prevention of proximal ulnar stump instability.
延伸閱讀
- Tsai., W. L. (1990). 以Shoji-Roth Chuinard手術式重建陳舊性第三度骨肩峰鎖骨關節損傷. Journal of Orthopaedic Surgery Taiwan, 7(4), 225-230. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199012-7-4-225-230-a
- Chen, C. E., & Wang, J. W. (1993). 一階段全人關節置換術治療高移位股骨頸骨折—病例報告. Journal of Orthopaedic Surgery Taiwan, 10(1), 145-150. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199303-10-1-145-150-a
- Shen, S. H., Lin, P. C., & Wang, J. W. (2008). 利用訂製式人工關節重建全人工髖關節置換後合併人工關節旁骨折不癒合與大量股骨缺損之病人：一病例報告. Journal of Orthopaedic Surgery Taiwan, 25(4), 182-188. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200812-25-4-182-188-a
- Lin, L. C., Tung, C. L., Ho, C. M., Lin, W. T., & Lin, H. C. (2018). 骨外固定裝置應用於下顎骨切除後重建的經驗－兩病例報告及文獻回顧. 臺灣口腔顎面外科學會雜誌, 29(2), 123-133. https://www.airitilibrary.com/Article/Detail?DocID=a0000494-201806-201807310018-201807310018-123-133
- 楊子萱、曾于娟、杜哲光、王薰儀、鄭裕民、胡愷芳、傅柏松、何坤炎、周郁翔（2014）。矯正治療合併引導組織再生術於全口重建中的跨科整合治療：病例報告。臺灣牙周病醫學會雜誌，19(4)，334-347。https://doi.org/10.6121/TAP.2014.19.4.06