Howlett John P C, Pfaeffle H James, Waitayawinyu Thanapong, Trumble Thomas E
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195-4743, USA.
J Hand Surg Am. 2008 Dec;33(10):1756-64. doi: 10.1016/j.jhsa.2008.08.022.
Treatment of scapholunate dissociation remains difficult. The modified Brunelli procedure, a flexor carpi radialis tenodesis through the scaphoid and secured with dorsal wrist ligaments, has shown promising results. This study compares the biomechanical effects on scaphoid flexion and scapholunate gap between proximal and distal tunnel placement in the modified Brunelli procedure.
Eight fresh-frozen cadaveric forearms were used. A dorsal approach to the wrist through the floor of the fourth compartment was used. Metallic markers were implanted into the scaphoid and lunate. Tunnels were drilled through the proximal and distal poles of the scaphoid. Wrists were positioned in neutral and loaded to 100 N through the wrist flexor and extensor tendons. Posteroanterior and lateral radiographs were taken with the scapholunate interval intact, with the scapholunate interval sectioned, and after the modified Brunelli tenodesis was performed through the proximal and then distal tunnels using Mersilene tape. Radiographs were analyzed for change in scapholunate angle and scapholunate gap. Multivariate analysis of variance was performed to assess statistical significance for each state compared with the intact wrist.
In the intact wrist, the mean scapholunate gap was 1.6 mm +/- 0.1. With the scapholunate interval sectioned, the scapholunate angle increased by 26 degrees +/- 12 and gap increased to 4.2 mm +/- 1.2. With a proximal tunnel for the modified Brunelli procedure, the change in scapholunate angle decreased to 15 degrees +/- 10 and gap decreased to 1.8 mm +/- 0.3. With a distal tunnel for the modified Brunelli procedure, the change in scapholunate angle decreased to 4 degrees +/- 7 and gap decreased to 1.3 mm +/- 0.2.
These biomechanical data suggest that a tunnel exiting in the distal pole of the scaphoid results in better correction of scaphoid flexion when performing the modified Brunelli procedure.
舟月骨分离的治疗仍然具有挑战性。改良布鲁内利手术，即通过舟骨进行桡侧腕屈肌腱固定并由腕背侧韧带固定，已显示出有前景的结果。本研究比较了改良布鲁内利手术中近端和远端隧道放置对舟骨屈曲和舟月间隙的生物力学影响。
使用8具新鲜冷冻的尸体前臂。采用通过第四腕管底部的腕背侧入路。将金属标记物植入舟骨和月骨。在舟骨的近端和远端极钻孔。将腕关节置于中立位，通过腕屈肌腱和伸肌腱加载至100 N。在舟月间隙完整时、舟月间隙切断后以及使用Mersilene带通过近端隧道然后远端隧道进行改良布鲁内利肌腱固定术后，拍摄正位和侧位X线片。分析X线片上舟月角和舟月间隙的变化。进行多因素方差分析以评估与完整腕关节相比每种状态的统计学意义。
在完整腕关节中，平均舟月间隙为1.6 mm±0.1。舟月间隙切断后，舟月角增加26°±12°，间隙增加至4.2 mm±1.2。对于改良布鲁内利手术采用近端隧道时，舟月角变化降至15°±10°，间隙降至1.8 mm±0.3。对于改良布鲁内利手术采用远端隧道时，舟月角变化降至4°±7°，间隙降至1.3 mm±0.2。
这些生物力学数据表明，在进行改良布鲁内利手术时，在舟骨远端极穿出的隧道能更好地矫正舟骨屈曲。
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