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

Publication History

Article published online:
30 March 2023

• Literatur

• 1 Bain GI, Baker A, Whipple TL. et al. History of Wrist Arthroscopy. J Wrist Surg 2022; 11: 96-119
• 2 Wong CW, Ho PC. Evolution and Inspiration from Hand and Wrist Arthroscopy. Hand Clin 2017; 33: xv-xvi
• 3 Mutimer J, Green J, Field J. Comparison of MRI and wrist arthroscopy for assessment of wrist cartilage. J Hand Surg Eur Vol 2008; 33: 380-382
• 4 Gaulke R, Abdulkareem M, O’Loughlin PF. et al. First clinical experience with a novel forearm boom. Technol Health Care 2010; 18: 317-324
• 5 Shim JW, Park MJ. Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis. Hand Clin 2017; 33: 779-785
• 6 Ho PC. Arthroscopic partial wrist fusion. Tech Hand Up Extrem Surg 2008; 12: 242-265
• 7 Michelotti BF, Chung KC. Diagnostic Wrist Arthroscopy. Hand Clin 2017; 33: 571-583
• 8 Hoyle AC, Talwalkar SC, Raj Murali S. Bare bones: Fundamentals of diagnostic wrist arthroscopy. J Clin Orthop Trauma 2021; 20: 101478
• 9 Iwata T, Ito H, Furu M. et al. Systemic effects of surgical intervention on disease activity, daily function, and medication in patients with rheumatoid arthritis. Scand J Rheumatol 2016; 45: 356-362
• 10 Schill S, Lühr T, Thabe H. Die radioulnäre Teilarthrodese zur Stabilisierung des rheumatischen Handgelenkes Mittel-langfristige Ergebnisse. Z Rheumatol 2002; 61: 551-559
• 11 Murray PM. Radioscapholunate arthrodesis. Hand Clin 2005; 21: 561-566
• 12 Gaulke R, O’Loughlin PF, Kendoff D. et al. Radiolunate fusion in the rheumatoid wrist via three point fixation with a mini-titanium-T-plate and oblique screw. Technol Health Care 2009; 17: 345-351
• 13 Masuko T, Iwasaki N, Ishikawa J. et al. Radiolunate fusion with distraction using corticocancellous bone graft for minimizing decrease of wrist motion in rheumatoid wrists. Hand Surg 2009; 14: 15-21
• 14 Gaulke R, Krettek C. Radiolunäre, radioskapholunäre und totale Handgelenkarthrodese bei rheumatischer Handgelenkinstabilität. Obere Extremität 2008; 3: 92-100