Bain Gregory Ian, Ondimu Phillip, Hallam Peter, Ashwood Neil
Department of Orthopaedic Surgery, Modbury Public Hospital, Modbury, South Australia, Australia.
Hand Surg. 2009;14(2-3):73-82. doi: 10.1142/S021881040900427X.
The purpose of this prospective study was to evaluate pain levels, range of motion, patient activity and satisfaction after radioscapholunate (RSL) arthrodesis. This was in association with distal scaphoid excision and complete resection of the triquetrum. The non-union rate for radioscapholunate arthrodesis was examined and the results compared with previous studies. Twenty-three patients (14 males and nine females) with an average age of 47 (range 26-73) years underwent RSL fusion for post-traumatic osteoarthritis, rheumatoid arthritis and Kienböck's disease of the lunate with a mean follow-up of 32 (range 13-70) months. The absolute prerequisite for any of these groups of patients was a functional midcarpal joint which was assessed pre-operatively with radiographs and intra-operatively prior to RSL fusion. The average flexion to extension motion changed from 66 degrees to 57 degrees . The ulnoradial range of motion also increased to 43 degrees from a pre-operative value of 22 degrees . The patients visual analogue pain scores reduced from an average of 64 to 28 (p = 0.01). Nineteen patients had no restriction in activity and all but one was satisfied with the outcome. All patients remained in full time employment with ten returning to some form of sport. RSL fusion with excision of the distal pole of the scaphoid and the entire triquetrum led to minimal reduction in the flexion-extension arc of motion and an increase in the ulnoradial arc. There was also good pain relief and maintenance of a patient's function. Memory staples are also an effective method of securing fusion in the wrist obtaining similar results to that seen in forefoot surgery.
这项前瞻性研究的目的是评估桡舟月关节融合术（RSL）后的疼痛程度、活动范围、患者活动情况及满意度。该手术联合舟骨远端切除术和三角骨完全切除术进行。研究了桡舟月关节融合术的不愈合率，并将结果与先前的研究进行比较。23例患者（14例男性和9例女性），平均年龄47岁（范围26 - 73岁），因创伤后骨关节炎、类风湿关节炎和月骨缺血性坏死接受RSL融合术，平均随访32个月（范围13 - 70个月）。对于这些患者群体中的任何一组，绝对前提条件是一个功能正常的腕中关节，术前通过X线片评估，术中在进行RSL融合术前评估。平均屈伸活动度从66度变为57度。尺桡侧活动范围也从术前的22度增加到43度。患者的视觉模拟疼痛评分从平均64分降至28分（p = 0.01）。19例患者活动无受限，除1例患者外，所有患者对结果满意。所有患者仍全职工作，10例患者恢复了某种形式的运动。切除舟骨远端和整个三角骨的RSL融合术导致屈伸运动弧度的减少最小，尺桡侧弧度增加。疼痛也得到了很好的缓解，患者功能得以维持。记忆钉也是确保腕关节融合的有效方法，其结果与前足手术所见相似。
