Winkler F J, Borisch N, Rath B, Grifka J, Heers G
Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum, Bad Abbach.
Z Orthop Unfall. 2010 May;148(3):332-7. doi: 10.1055/s-0029-1240757.
Successful four-corner fusion after scaphoid excision provides pain relief und preserves an acceptable movability of the wrist. However, this treatment option for advanced carpal collapse is not without complications, such as malunion, hardware impingement or incomplete correction of lunate extension. K-wires, staples, Herbert screws or, recently, locking plates are all possible fixation techniques after scaphoid excision. Only a few studies including mid-term results using K-wires are available. The aim of our study was to evaluate clinical and radiological mid-term results after scaphoid excision and four-corner arthrodesis using K-wires for stage II and III scapholunate and scaphoid non-union advanced collapse.
Twelve wrists of 11 patients (4/SNAC II degrees, 3/SNAC III degrees, 0/SLAC II degrees, 5/SLAC III degrees) were treated operatively by scaphoid excision and four-corner arthrodesis. Four K-wires were used for osteosynthesis. After an average follow-up of 60.25 months, reexamination included subjective, objective and radiological values. Clinical examinations covered wrist motion, grip strength and pinch strength. These parameters were compared with preoperatively collected data and values of the unaffected side. The DASH score (disabilities of the arm, shoulder and hand), Cooney score and the visual analogue scale (VAS 0-10) were analysed. Radiographic assessment of consolidation was verified by conventional X-rays. The carpal height was compared to the preoperative value by assessing the Youm index.
All patients were satisfied, pain relief was reported and displayed on VAS from 7.4 (5-10) to 1.4 (0-5). The mean flexion-extension arc of 76.3 +/- 28.8 degrees (59.7% of the opposite wrist), preoperatively 75 +/- 17.3 degrees, was documented. The average total arc of ulnar and radial deviation was 37.5 +/- 9.2 degrees (51% of the opposite wrist). The preoperative value was 33.5 +/- 9.8 degrees. Further clinical evaluation yielded a mean grip strength of 39.3 kp (89.5% of the anaffected side) and pinch strength of 7.6 kp (81.7%). Total DASH score and Cooney score averaged 15 and 74.17 points, respectively. Osseus consolidation was observed radiologically in all patients already after 6 weeks. The Youm index decreased from 0.55 +/- 0.054 to 0.51 +/- 0.057. The radiolunate joint space remained unaltered in height. There were no infections. Except for wire removal, no additional surgery was necessary.
Scaphoid excision and four-corner arthrodesis for advanced collapse of the wrist enjoy great satisfaction by the patients, with a high degree of pain reduction. This method shows persistent strength and movability in mid-term-results. Compared to alternative fixation techniques, the use of K-wires is a low-risk and low-cost treatment option, although removal of the K-wires is commonly necessary.
舟骨切除术后成功的四角融合可缓解疼痛并保留可接受的腕关节活动度。然而，这种针对晚期腕骨塌陷的治疗方法并非没有并发症，如骨不连、内固定物撞击或月骨伸展未完全矫正。克氏针、钉、Herbert螺钉或最近的锁定钢板都是舟骨切除术后可能的固定技术。仅有少数研究包含使用克氏针的中期结果。我们研究的目的是评估使用克氏针对II期和III期舟月骨和舟骨不愈合晚期塌陷进行舟骨切除及四角关节融合术后的临床和影像学中期结果。
11例患者的12个腕关节（4例舟月骨进展性塌陷II度，3例舟月骨进展性塌陷III度，0例舟月关节进展性塌陷II度，5例舟月关节进展性塌陷III度）接受了舟骨切除及四角关节融合手术治疗。使用4根克氏针进行骨固定。平均随访60.25个月后，复查包括主观、客观和影像学指标。临床检查涵盖腕关节活动度、握力和捏力。将这些参数与术前收集的数据以及未受影响侧的值进行比较。分析了手臂、肩部和手部功能障碍评分（DASH评分）、Cooney评分和视觉模拟量表（VAS 0 - 10）。通过传统X线片对骨愈合进行影像学评估。通过评估Youm指数将腕骨高度与术前值进行比较。
所有患者均感到满意，报告疼痛缓解，VAS评分从7.4（5 - 10）降至1.4（0 - 5）。记录到平均屈伸弧为76.3±28.8度（对侧腕关节的59.7%），术前为75±17.3度。尺桡偏平均总弧为37.5±9.2度（对侧腕关节的51%）。术前值为33.5±9.8度。进一步的临床评估得出平均握力为39.3kp（未受影响侧的89.5%），捏力为7.6kp（81.7%）。DASH总分和Cooney评分平均分别为15分和74.17分。所有患者在6周后影像学检查均观察到骨愈合。Youm指数从
