Gaston R Glenn, Greenberg Jeffrey A, Baltera Robert M, Mih Alex, Hastings Hill
OrthoCarolina, Charlotte, NC 28204, USA.
J Hand Surg Am. 2009 Oct;34(8):1407-12. doi: 10.1016/j.jhsa.2009.05.018. Epub 2009 Sep 6.
To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthrodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis.
We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strength; visual analog scale (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthroplasty, and pisotriquetral arthritis were recorded.
Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strength, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision.
Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strength, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the lunate following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concern with this technique.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
比较舟骨和三角骨切除联合头月关节融合术与四角（头状骨、钩骨、月骨、三角骨）腕骨间融合术的临床疗效。
我们回顾性纳入了50例行四角融合术的舟月骨晚期塌陷性腕关节改变患者。34例患者能够复诊并完成所有随访评估。两组患者的人口统计学特征相似。随访评估包括X线片、腕关节活动范围（屈伸、桡尺偏、旋前旋后）、握力、视觉模拟评分（VAS）以及上肢、肩部和手部功能障碍（DASH）问卷。记录骨不连、内固定移位、转为腕关节融合术或关节成形术以及豌豆三角关节炎等并发症。
16例患者行头月关节融合术，18例患者行四角融合术。两组之间在桡尺偏、旋前旋后、握力、VAS或DASH评分方面无统计学差异。四角融合术组的屈伸活动度略有增加。四角融合术组有2例骨不连，头月关节融合术组无骨不连。头月关节融合术组有5例患者因螺钉移位需要取出螺钉。四角融合术组有3例患者需要二期切除豌豆骨。
在本系列平均3年的随访中，头月关节融合术在活动范围、握力、DASH评分和VAS方面与四角融合术相比具有优势。头月关节融合术的优点包括减少了取骨需求，同时保持了相似的低骨不连率，三角骨切除后月骨复位更容易，并且避免了随后出现的症状性豌豆三角关节炎。然而，螺钉移位仍是该技术需要关注的问题。
研究类型/证据水平：治疗性III级。
