Megerle K, Bertel D, Germann G, Lehnhardt M, Hellmich S
Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
J Bone Joint Surg Br. 2012 Dec;94(12):1660-5. doi: 10.1302/0301-620X.94B12.30007.
The purpose of this study was to assess the clinical and radiological outcomes of dorsal intercarpal ligament capsulodesis for the treatment of static scapholunate instability at a minimum follow-up of four years. A total of 59 patients who underwent capsulodesis for this condition were included in a retrospective analysis after a mean of 8.25 years (4.3 to 12). A total of eight patients underwent a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were excluded. The mean range of extension/flexion was 88° (15° to 135°) and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up. The mean Disabilities of the Arm Shoulder and Hand (DASH) score and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively. After significant improvement immediately post-operatively (p < 0.001 and p = 0.001, respectively), the mean scapholunate and radiolunate angles deteriorated to 70° (40° to 90°) and 8° (-15° to 25°), respectively, at final follow-up, which were not significantly different from their pre-operative values (p = 0.6 and p = 0.4, respectively). The mean carpal height index decreased significantly from 1.53 (1.38 to 1.65) to 1.48 (1.29 to 1.65) indicating progressive carpal collapse (p < 0.001); 40 patients (78%) had radiological evidence of degenerative arthritis. Capsulodesis did not maintain carpal reduction over time. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist.
本研究的目的是评估腕背侧腕间韧带关节囊固定术治疗静态舟月骨不稳定的临床和影像学结果，随访时间至少为四年。共有59例因该疾病接受关节囊固定术的患者在平均8.25年（4.3至12年）后纳入回顾性分析。共有8例患者在平均2.33年（0.67至7.6年）时接受了挽救手术并被排除。末次随访时，平均伸展/屈曲范围为88°（15°至135°），尺偏/桡偏范围为38°（0°至75°）。手臂、肩部和手部功能障碍（DASH）平均评分和梅奥腕关节评分分别为28分（0至85分）和61分（0至90分）。术后立即有显著改善（分别为p < 0.001和p = 0.001），但在末次随访时，舟月角和桡月角平均分别恶化至70°（40°至90°）和8°（-15°至25°），与术前值无显著差异（分别为p = 0.6和p = 0.4）。平均腕骨高度指数从1.53（1.38至1.65）显著下降至1.48（1.29至1.65），表明腕骨逐渐塌陷（p < 0.001）；40例患者（78%）有退行性关节炎的影像学证据。随着时间的推移，关节囊固定术未能维持腕骨复位。尽管随之而来的持续舟月骨不稳定导致早期关节炎退变，但大多数患者的腕关节长期功能尚可。
