Möglichkeiten und Grenzen der Arthroskopie des rheumatischen Handgelenkes

Zusammenfassung

Die arthroskopische Synovialektomie am Knie-, Schulter-, Ellenbogen- und oberen Sprunggelenk hat in der operativen Therapie entzündlich-rheumatischer Erkrankungen trotz verbesserter medikamentöser Therapie weiterhin eine überragende Bedeutung in Bezug auf den Gelenkserhalt bei therapieresistenter Synovialitis. Das Handgelenk und distale Radioulnargelenk bilden zusammen 3 Gelenkräume, welche bei der Arthroskopie zu adressieren sind. Arthroskopisch kontrollierte perkutane Teilversteifung am Handgelenk haben den Vorteil geringerer periartikulärer Vernarbung. Eine Immobilisation ist nach der Schraubenarthrodese im Gegensatz zur offenen Plattenarthrodese obligat. Die totale Synovialektomie sowie arthroskopische Teilarthrodesen sind technisch sehr anspruchsvoll und sollten daher erfahrenen Handgelenkarthroskopeuren vorbehalten bleiben.

Abstract

Despite the increased therapeutic value of drug therapy with biologicals and small molecules for rheumatoid diseases, total synovectomy is still of outstanding importance for joint preservation in patients with persistent synovitis. Total synovectomy is well established in rheumatoid knees, shoulders, elbows, and ankle joints. Compared with these joints, arthroscopic synovectomy in the wrist is technically more difficult because three small and curved compartments, the radiocarpal, mediocarpal, and distal radioulnar joint, have to be addressed. Partial wrist fusion is an important tool for wrist stabilisation preserving some range of motion in rheumatoid wrists. Arthroscopic percutaneous wrist fusion combined with total synovectomy is indicated if periarticular surgery is not required, e. g. for tenosynovectomy of the extensor tendons. Surgeons should be well experienced with wrist arthroscopy before starting to perform these procedures.

Schlüsselwörter

Rheumatoide Arthritis - Handgelenkarthroskopie - karpale Synovialektomie - arthroskopische Handgelenkarthrodesen - radioskapholunäre Arthrodese

Key words

Rheumatoid arthritis - wrist arthroscopy - wrist synovectomy - arthroscopic wrist fusion - radioscapholunate fusion

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