Larson Timothy Brad, Gaston Raymond Glenn, Chadderdon Robert Christopher
Carolinas Medical Center †OrthoCarolina, Charlotte, NC, USA.
Tech Hand Up Extrem Surg. 2012 Sep;16(3):135-40. doi: 10.1097/BTH.0b013e318257595b.
Injuries to the scapholunate (SL) interosseous ligament can have devastating consequences to carpal stability. The purpose of this study is to provide a technique for screw augmentation to SL reconstruction, while comparing radiographic outcomes to a traditional Kirschner wire fixation cohort.
A retrospective review of all patients treated by screw fixation for SL ligament injuries was cross-matched to a cohort of patients treated with pin fixation for age and length of time from the time of injury to surgical fixation. Outcomes were the values of SL gap and SL angle on plain radiographs as averaged between 2 independent reviewers, as well as complications.
Seven patients who received screw augmentation had an average follow-up of 8.7 months. When compared with the Kirschner wire cohort, there was improvement of immediate postoperative gap in the screw cohort of 3.1 versus 1.3 mm. There was also better reduction in SL angle in the screw group (22 vs. 10.4 degrees correction). At 4 months follow-up, both the SL gap and SL angle were maintained better in the screw group. There was 1 infection in each cohort, 1 pin migration in a screw/pin combination patient counted in the screw group, and 1 pin migration in the pin cohort.
Our study suggests that temporary screw augmentation for SL ligament injuries results in more effective SL gap and SL angle correction both immediately and in short-term follow-up than does pin fixation. Longer follow-up is needed to evaluate longevity of reduction, and larger, prospective studies with clinical outcomes are needed to show statistically significant benefits to screw augmentation.
舟月骨间韧带损伤会对腕关节稳定性造成严重后果。本研究旨在提供一种用于舟月骨重建的螺钉增强技术，同时将影像学结果与传统克氏针固定组进行比较。
对所有接受螺钉固定治疗舟月韧带损伤的患者进行回顾性分析，并与一组因年龄和受伤至手术固定时间长度匹配的接受钢针固定的患者进行交叉对照。结果包括由两名独立评估者平均得出的X线平片上舟月间隙和舟月角的值，以及并发症情况。
7例接受螺钉增强治疗的患者平均随访8.7个月。与克氏针组相比，螺钉组术后即刻间隙改善为3.1毫米，而克氏针组为1.3毫米。螺钉组的舟月角矫正也更好（22度对10.4度）。在4个月随访时，螺钉组的舟月间隙和舟月角维持得更好。每组各有1例感染，螺钉组中有1例螺钉/钢针联合固定患者出现1次钢针移位，钢针组中有1例钢针移位。
我们的研究表明，对于舟月韧带损伤，临时螺钉增强在即刻和短期随访中比钢针固定能更有效地矫正舟月间隙和舟月角。需要更长时间的随访来评估复位的持久性，并且需要更大规模的具有临床结果的前瞻性研究来证明螺钉增强具有统计学意义的益处。
