Die operative Korrektur rheumatischer Handgelenkdeformitäten – Tipps und Tricks

Zusammenfassung

Die Mitbeteiligung der Hand und des Handgelenkes ist im Krankheitsverlauf einer Rheumatiden Arthritis (RA) in nahezu 70% der Verläufe ein sehr häufiges Ereignis. Der schleichende Verlust der Handfunktion bei RA-Patienten wirkt sich auf ihre Fähigkeit zur Selbstpflege bis hin zur gesellschaftlichen Teilhabe aus. Allerdings hat sich das Erkrankungsmuster seit Einführung der Biologika verändert. Die fulminanten Entzündungsformen werden deutlich seltener und ebenso die Frequenz operativer Interventionen. Aber gerade Verlaufsformen mit unzureichendem Ansprechen auf „moderne Basistherapeutika“ erfordern weiterhin eine engmaschige Kontrolle damit die Patienten auch langfristig keinen wesentlichen Funktionsverlust erleiden. Chirurgische Eingriffe des arthritischen Handgelenkes können in präventive und solche mit therapeutisch-rekonstruktiven Anspruch unterteilt werden. Die Ergebnisse profitieren unzweifelhaft durch das gewachsene biomechanische Verständnis. Wesentliche Verbesserungen der Implantate erhöhen zunehmend auch den Stellenwert endoprothetischer Verfahren. Unbedingt geboten ist dabei in einem multidisziplinären Team orthopädisch- und internistisch rheumatologisch koordiniert im Sinne des RA Patienten zu handeln.

Abstract

The involvement of the hand and wrist in the disease process of rheumatoid arthritis (RA) is a very common event occurring in almost 70% of patients. Gradual loss of hand function in RA patients affects their ability for self-care and interferes with their productivity in society. However, the disease pattern has changed since the introduction of biologics. The frequency of fulminant forms of inflammation has decreased a lot, as has the frequency of surgical interventions. However, disease patterns with inadequate response to “modern DMARDs” continue to require close monitoring so that patients suffer no significant loss of function in the long run. Surgical interventions for RA hand involvement can be divided into prophylactic and therapeutic/reconstructive procedures. The results of arthritic wrist surgery undoubtedly benefit from the increased biomechanical understanding. Significant improvements in implant durability also increase the value of wrist arthroplasty procedures. A coordinated collaboration between orthopaedists and rheumatologists is mandatory to provide the best outcome for RA patients.

Schlüsselwörter

Synovektomie - Handgelenkarthrodese - Caput ulnae Syndrom - Arthroplastik Handgelenk

Key words

synovectomy - total wrist arthrodesis - caput ulnae syndrome - total wrist arthroplasty

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