Links Annie C, Chin Simon H, Waitayawinyu Thanapong, Trumble Thomas E
Hand Surgery Institute, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA 98195-6500, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):850-6. doi: 10.1016/j.jhsa.2008.02.010.
To compare clinical and radiographic outcomes in patients with chronic scapholunate dissociation treated with a modified Brunelli technique versus a 4-bone tendon weave.
A retrospective cohort study was performed. Twenty-three patients presented with chronic scapholunate dissociation and were treated with the 4-bone tendon weave technique as described by Almquist and colleagues. A separate group of 21 patients were subsequently treated with a modified Brunelli plus reduction-assisted scapholunate ligament technique. All patients had preoperative radiographs demonstrating scapholunate ligament disruption and positive magnetic resonance arthrograms. All were treated by the senior surgeon (T.E.T.), who initially performed the 4-bone tendon weave and later the modified Brunelli procedure plus temporary screw fixation. Evaluation included radiographic changes, pain and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip strength, and range of motion. Data were analyzed using the Wilcoxon signed rank test for preoperative-to-postoperative comparisons and the Wilcoxon-Mann-Whitney test for comparison between the 2 treatment groups.
The scapholunate angle decreased in both groups (mean 15 degrees +/- 5 decrease for the Brunelli group; 10 degrees +/- 4 decrease in the 4-bone tendon weave group). Mean pain and DASH scores preoperatively and postoperatively demonstrated greater improvement for the modified Brunelli group (pain scores rated on a visual analog scale of 1 to 10: mean difference Brunelli group = 4.8 cm; 4-bone tendon weave group = 3.2 cm; mean difference 1.6 cm; DASH scores: mean difference Brunelli group = 31.5 points; 4-bone tendon weave group = 14.2 points). The Brunelli group also experienced greater postoperative motion as a percentage of preoperative motion (mean 86% +/- 7 vs 60% +/- 12) and significant increases in postoperative versus preoperative grip strength (mean 2 kg vs 1 kg; increase of 1 kg).
The modified Brunelli technique for scapholunate interosseous ligament reconstruction compared with the 4-bone tendon weave technique has improved outcomes in pain relief, DASH scores, range of motion, and grip strength at 2.5 years follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
比较采用改良布鲁内利技术与四骨肌腱编织术治疗慢性舟月关节分离患者的临床和影像学结果。
进行一项回顾性队列研究。23例慢性舟月关节分离患者采用阿尔姆奎斯特及其同事描述的四骨肌腱编织技术进行治疗。随后，另一组21例患者采用改良布鲁内利加复位辅助舟月韧带技术进行治疗。所有患者术前X线片均显示舟月韧带断裂，磁共振关节造影呈阳性。所有患者均由资深外科医生（T.E.T.）治疗，该医生最初进行四骨肌腱编织术，后来进行改良布鲁内利手术加临时螺钉固定。评估内容包括影像学变化、疼痛以及手臂、肩部和手部功能障碍（DASH）问卷评分、握力和活动范围。使用Wilcoxon符号秩检验进行术前与术后比较，使用Wilcoxon-Mann-Whitney检验进行两个治疗组之间的比较。
两组的舟月角均减小（布鲁内利组平均减小15°±5°；四骨肌腱编织组减小10°±4°）。改良布鲁内利组术前和术后的平均疼痛和DASH评分改善更大（疼痛评分采用1至10分的视觉模拟量表：布鲁内利组平均差异=4.8 cm；四骨肌腱编织组=3.2 cm；平均差异1.6 cm；DASH评分：布鲁内利组平均差异=31.5分；四骨肌腱编织组=14.2分）。布鲁内利组术后活动度占术前活动度的百分比也更高（平均86%±7%对60%±12%），术后握力较术前显著增加（平均2 kg对1 kg；增加1 kg）。
在2.5年的随访中，与四骨肌腱编织技术相比，改良布鲁内利技术用于舟月骨间韧带重建在缓解疼痛、DASH评分、活动范围和握力方面有更好的结果。
研究类型/证据水平：治疗性III级。
