Department for Hand, Plastic and Reconstructive Surgery, Burn Center - BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwig-Guttmannstr. 13, 67071 Ludwigshafen, Germany.
Injury. 2012 Mar;43(3):306-10. doi: 10.1016/j.injury.2011.08.015. Epub 2011 Sep 7.
Scaphoid malunion and carpal malalignment can result after scaphoid reconstruction, if the two fragments are not properly reduced before fixation. However, currently there is no information about which degree of deformity or malalignment can be tolerated without impairing clinical function. The purpose of this study was to investigate the influence of the scaphoid morphology and carpal alignment on clinical outcomes after scaphoid reconstruction. A total of 65 patients with an average age of 29 years were followed-up after a mean period of 45 months. In all patients, osseous union after a first-time scaphoid reconstruction in the middle third had been confirmed. Scapholunate (SL) and radiolunate (RL) angles were obtained on plain radiographs as were intrascaphoid (ISA) and dorsal cortical (DCA) angles and the height/length (H/L) ratio of the reconstructed scaphoid on computed tomography (CT) scans. These parameters were correlated with clinical outcome measures. RL angles correlated significantly with wrist range of motion, grip strength and pain levels, whilst SL angles, ISA, DCA and H/L ratio failed to show significant correlations. Our data suggest that clinical outcome is correlated with correct restoration of bone morphology and carpal alignment. After reconstruction, the RL angle should not exceed 10°.
舟骨畸形愈合和腕骨对线不良可发生于舟骨重建术后，如果在固定前两骨折块没有得到适当的复位。然而，目前尚无信息表明哪种程度的畸形或对线不良在不影响临床功能的情况下是可以被接受的。本研究旨在探讨舟骨形态和腕骨对线对舟骨重建术后临床结果的影响。共 65 例患者，平均年龄 29 岁，平均随访时间为 45 个月。所有患者均首次在中段行舟骨重建后获得骨性愈合。在 X 线片上测量舟月（SL）和月桡（RL）角，在 CT 扫描上测量舟骨内（ISA）和背侧皮质（DCA）角以及重建舟骨的高/长（H/L）比。这些参数与临床结果测量值相关。RL 角与腕关节活动度、握力和疼痛水平显著相关，而 SL 角、ISA、DCA 和 H/L 比与临床结果无显著相关性。我们的数据表明，临床结果与正确的骨形态和腕骨对线的恢复相关。重建后，RL 角不应超过 10°。
