リウマチ手関節障害に対する手術的治療法の検討 Ｓａｕｖｅ‐Ｋａｐａｎｄｊｉ法 ｖｓ Ｄａｒｒａｃｈ法

Abstract

The purpose of this paper is to make sure the role of Sauve-Kapandji and Darrach procedures to the rheumatoid wrist. The cases operated with Sauve-Kapandji and Darrach procedures were compared.The subjects were 12 cases with Sauve-Kapandji procedures and 7 cases with Darrach procedures, and follow-up ranged 1.2 to 7.4 years with an average of 3.7 years. Clinical evaluation was performed in terms of pain, range of motion, and instability of ulnar stump. Radiographic evaluation was performed in terms of carpal height ratio (CHR) and ulnocarpal distance ratio (UCDR).Pain relief was obtained in all patients with both procedures. Supination and Pronation improved after operation, whereas range of palmarflexion and dorsiflexion did not improve.CHR decreased in both group, and UCDR increased in the patients with Darrach procedure more than those with Sauve-Kapandji procedure. Especially after Darrach procedure, UCDR increased in the patients with the radial inclination more than 23°.Although the instability of the ulnar stump was observed in all patients, it was not so severe and no additional procedures were not needed.According to these results, the indications of Darrach procedure for the rheumatoid wrists are the follows.1) the cases with radiocarpal fusion2) the cases with destruction of ulnar head without radiocarpal (RC) fusion, which radial inclination is less than 23°.The indication of Sauve-Kapandji procedure is the cases with neither RC fusion nor destruction of ulnar head.For the cases with destruction of ulnar head without RC fusion, which radial inclinations are more than 23°, Darrach procedure with radiocarpal fusion is indicated.