Scobercea Razvan G, Budoff Jeffrey E, Hipp John A
Department of Orthopaedic Surgery, Baylor College of Medicine, University of Texas, Houston, TX 77030, USA.
J Hand Surg Am. 2009 Mar;34(3):381-6. doi: 10.1016/j.jhsa.2008.11.027.
To examine the biomechanical effects of triquetral and scaphoid excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner arthrodesis with rigid internal fixation.
Ten fresh-frozen cadaveric upper extremities were studied. For all surgical manipulations, the motion was measured and contact characteristics were assessed using ultralow prescale pressure-sensitive film.
Compared with the intact specimen, simple 4-corner arthrodesis with scaphoid retention led to a significant decrease in flexion (-23%), extension (-69%), radial deviation (-129%), and ulnar deviation (-25%), but no significant change in radiolunate contact characteristics. After 4-corner arthrodesis with scaphoid excision, there was a significant increase in radial deviation (+213%) without significant change in radiolunate contact characteristics, but average radial deviation was still less than in the intact specimen. After further excision of the triquetrum, radial deviation increased significantly (+238%), to a mean value 5% greater than that of the intact state, but at the cost of a significant increase in mean radiolunate contact pressure (+44% compared to the intact state).
When performing 4-corner arthrodesis, scaphoid and triquetrum excision may improve motion at the cost of increased mean radiolunate contact pressure.
在尸体模型中，通过刚性内固定模拟四角融合术后，研究三角骨和舟骨切除对腕关节活动度及桡月关节接触特性的生物力学影响。
对10具新鲜冷冻尸体上肢进行研究。对于所有手术操作，使用超低压预校准压敏膜测量运动并评估接触特性。
与完整标本相比，保留舟骨的单纯四角融合术导致屈曲（-23%）、伸展（-69%）、桡偏（-129%）和尺偏（-25%）显著降低，但桡月关节接触特性无显著变化。舟骨切除后的四角融合术后，桡偏显著增加（+213%），桡月关节接触特性无显著变化，但平均桡偏仍低于完整标本。进一步切除三角骨后，桡偏显著增加（+238%），平均值比完整状态高5%，但代价是平均桡月关节接触压力显著增加（与完整状态相比增加44%）。
进行四角融合术时，切除舟骨和三角骨可能会以增加平均桡月关节接触压力为代价来改善活动度。
