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DOI: 10.1055/s-0037-1618084
Ist der Swansonspacer immer noch Goldstandard beim rheumatisch destruierten Fingergelenk?
Swanson’s silicone arthroplasty is still the golden standard in rheumatoid destructed finger joints?Publication History
Publication Date:
26 December 2017 (online)
Zusammenfassung
Rheumatisch destruierte Fingergelenke sind großen exzentrisch wirkenden Kräften ausgesetzt, die durch den krankheitsbedingten Fehlverlauf der gelenkübergreifenden Sehnen bedingt sind. Eine kräfterezentrierende Zwangsführung über Prothesen führt daher zwangsweise zu einem Bruch oder Ausbruch des Implantats. Die von Swanson vor etwa 50 Jahren inaugurierte Stabilisierung einer Resektionsarthroplastik durch ein Silikonimplantat umgeht die Problematik der implantatgeführten Kraftübertragung. Das Implantat ermöglicht durch Ausrichtung der peri implantären Vernarbung eine Korrektur der rheumatypischen Fehlstellungen. Verlässliche Rekonstruktionstechniken der periartikulären Strukturen zur Sehnenrezentrierung sind bis heute nicht etabliert worden. Die Silikonarthroplastik darf daher weiterhin als Goldstandard gelten, obwohl neuere Modifikationen des Silikonspacers tendenziell eine Verbesserung der eingeschränkten postoperativen Beweglichkeit ermöglichen.
Summary
Excentric displacement of tendons in rheumatoid hands generates high deviating loads on destructed joints. Recentation of the deviating forces by endoprotheses is frequently followed by fracture or loosening of the implants. Silicone arthroplasty, which was developed by Swanson about 50 years ago, avoids these problems. Scar formation around the silicone implant called encapsulation process corrects joint deviation and allows limited range of motion. Silicone arthroplasty will remain the golden standard in finger joint arthroplasty as long as reliable repair of the periarticular structures is not available. New modifications of the silicone implant afford slightly better ROM compared with the Swanson implant.
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