Galvis Elkin J, Kumar Kannan K, Özyurekoglu Tuna
Kleinert and Kutz Hand Care Center, Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY 40202, USA.
Tech Hand Up Extrem Surg. 2013 Jun;17(2):80-3. doi: 10.1097/BTH.0b013e318280e9cc.
Radioscapholunate arthrodesis is a desirable method to treat isolated radiolunate arthritis or ulnar translocation of the carpal bones. An intact midcarpal joint is a prerequisite for functional range of motion. Previously, high rates of nonunion were observed with these procedures, as rigid fixation was difficult to obtain with simple Kirschner wires and screws. A successful outcome depends on bringing the scaphoid, lunate, and the radius to an anatomic alignment, and rigid fixation of the arthrodesis. We describe a technique for the arthrodesis of the radioscapholunate joint from the dorsal side using a low-profile locking Pi plate. We observed the advantages of an easy approach, better visualization of the joint, and easier manipulation of the carpal bones. The Pi plate fits on the scaphoid, lunate, and the radius with minimal adjustment. It is not necessary to remove the Lister's tubercle. Pi plate allows for rigid fixation and compression between the scaphoid, lunate, and the radius by 1 compression and 1 locking screw in scaphoid and lunate, and by 2 eccentric compression screws in the radius. Rectangular retinacular flaps were used under and over the extensor tendons. We performed these arthrodeses in patients with lunate fossa arthritis after a distal radius fracture, and with ulnar translocation of the carpus. We have observed excellent clinical results with about 50% of wrist motion preserved and no cases of nonunion or delayed union.
桡舟月关节融合术是治疗孤立性桡月关节炎或腕骨尺侧移位的理想方法。完整的腕中关节是实现功能活动范围的前提条件。以前，这些手术的不愈合率较高，因为使用简单的克氏针和螺钉难以实现牢固固定。成功的结果取决于使舟骨、月骨和桡骨达到解剖学对线，并对关节融合进行牢固固定。我们描述了一种使用低轮廓锁定Pi板从背侧进行桡舟月关节融合的技术。我们观察到该方法具有入路简便、关节视野更好以及腕骨操作更容易等优点。Pi板只需进行最小程度的调整就能适配舟骨、月骨和桡骨。无需切除Lister结节。Pi板通过在舟骨和月骨上各使用1枚加压和锁定螺钉以及在桡骨上使用2枚偏心加压螺钉，可实现舟骨、月骨和桡骨之间的牢固固定和加压。在伸肌腱下方和上方使用了矩形支持带瓣。我们对桡骨远端骨折后出现月骨窝关节炎以及腕骨尺侧移位的患者实施了这些关节融合术。我们观察到了出色的临床效果，保留了约50%的腕关节活动度，且无不愈合或延迟愈合病例。
