Der Posttraumatische Karpale Kollaps: Entstehung Und Therapiekonzept
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Das Handgelenk ist in seiner Konstruktion einzigartig. Es verbindet einen gro en Bewegungsumfang mit der Fähigkeit, in jeder Position Kraft zu übertragen. Ermöglicht wird dies durch die Einschaltung eines Zwischen- segmentes in Form der proximalen Handwurzelreihe, die einem unter Spannung stehenden Ring zu vergleichen ist. Solange dieser intakt ist, wer- den die Eigenbewegungstendenzen von Skaphoid und von Lunaturn kom- pensiert. Platzt er jedoch auf, sei es durch eine Fraktur des Kahnbeines oder durch eine Ruptur des skapholunären Bandes, so können Skaphoid und Lunaturn ihren individuellen Bewegungstendenzen folgen: Das Ska- phoid rotiert in Flexion, während das Lunaturn in Extensionsstellung nach palmar translatiert. Unbehandelt führen Verkantungen der Gelenkflächen gegeneinander zur vorzeitigen Arthrose und schlie lich zum karpalen Kollaps. Eine neue Möglichkeit der Behandlung des fortgeschrittenen karpalen Kollapses hat Watson im Jahr 1981 mit der mediokarpalen Teilarthrodese eröffnet. Im Gegensatz zur Totalarthrodese des Handgelenkes wird hier eine Restbeweglichkeit im radiolunären Gelenkabschnitt erhalten. Die vorlie- gende Arbeit beschäftigt sich ausführlich mit diesem Verfahren. Der Autor beschreibt, wie in den vergangenen 10 Jahren die Technik dieser Operation verfeinert, standardisiert und in über 300 eigenen Fällen klinisch ange- wandt wurde. Die Ergebnisse werden sowohl nach traditionellen Bewer- tungsschemata als auch nach einem patientenorientierten Score für die obere Extremität (DASH-Score) bewertet. Dieser Score dient gleichsam als Messlatte für die Behinderung, die der Patient durch eine pathologische Ver- änderung an seiner oberen Extremität erfährt, zunächst unabhängig von der Diagnose oder der Art einer Therapie.
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