Ozyurekoglu Tuna, Turker Tolga
Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville, Louisville, KY 40202, USA.
J Hand Surg Am. 2012 Mar;37(3):486-92. doi: 10.1016/j.jhsa.2011.12.022. Epub 2012 Feb 1.
To evaluate the functional and radiographic results of a scaphoid excision and four-corner arthrodesis technique using percutaneous headless compression screws.
A cohort of 33 patients, mean age 51 (range, 20-72) years, was treated for scapholunate advanced collapse (19), scaphoid nonunion advanced collapse (12), midcarpal instability (1), and Preiser disease (1). After scaphoid excision and removal of cartilage and subchondral bone in the midcarpal joint through a limited arthrotomy, capitolunate fixation was achieved with a percutaneous, transmetacarpal Acutrak screw (Acumed LLC, Hillsboro, OR), and triquetrohamate fixation was done with a percutaneous screw. Scaphoid was used as a bone graft. The average follow-up time was 8 months (n = 32; range, 6-64 mo).
Union occurred in 31 of 33 wrists (94%). One of the 33 patients had total wrist arthrodesis. Average total active flexion-extension arc was 71° after surgery and 83° before surgery. The postoperative carpal height averaged 0.47 compared to preoperative values of 0.45. The percentage of grip strength significantly improved from 41% before surgery to 80% after surgery. Postoperative mean verbal numerical rating scale pain score was less than 1, statistically better than the preoperative score of 7. Twenty-five of 33 patients were completely pain free. The average postoperative Mayo wrist score was 74, a significant improvement over the preoperative average of 40. Final Disabilities of the Arm, Shoulder, and Hand scores averaged 13 (n = 32; range, 0-49).
These results were comparable to or better than the results of previously published techniques in terms of fusion rates, alleviation of pain, grip strength, range of motion; Mayo wrist score; and Disabilities of the Arm, Shoulder, and Hand questionnaire score. The technique exploits the theoretical advantages of strong compression between carpals while avoiding a screw-head sized hole in the lunate articular cartilage and preserving the dorsal capsular ligament attachments to the triquetrum.
评估使用经皮无头加压螺钉的舟骨切除及四角融合技术的功能和影像学结果。
对33例患者进行治疗，平均年龄51岁（范围20 - 72岁），病因包括舟月骨晚期塌陷（19例）、舟骨不愈合晚期塌陷（12例）、腕中关节不稳（1例）和Preiser病（1例）。通过有限切开术切除舟骨并去除腕中关节的软骨和软骨下骨后，使用经皮经掌骨的Acutrak螺钉（Acumed LLC，希尔斯伯勒，俄勒冈州）实现头月骨固定，并用经皮螺钉进行三角骨与钩骨固定。使用舟骨作为骨移植材料。平均随访时间为8个月（n = 32；范围6 - 64个月）。
33例手腕中有31例实现融合（94%）。33例患者中有1例行全腕关节融合术。术后平均总主动屈伸弧为71°，术前为83°。术后腕骨高度平均为0.47，术前值为0.45。握力百分比从术前的41%显著提高到术后的80%。术后平均言语数字评定量表疼痛评分为小于1分，在统计学上优于术前的7分。33例患者中有25例完全无痛。术后平均Mayo腕关节评分为74分，显著高于术前平均40分。最终手臂、肩部和手部功能障碍评分平均为13分（n = 32；范围0 - 49）。
在融合率、疼痛缓解、握力、活动范围、Mayo腕关节评分以及手臂、肩部和手部功能障碍问卷评分方面，这些结果与先前发表的技术相当或更好。该技术利用了腕骨间强力加压的理论优势，同时避免在月骨关节软骨上形成螺钉头大小的孔，并保留了背侧关节囊韧带与三角骨的附着。
