Yang Yong, Kumar Kannan K, Tsai Tsu-Min
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky ; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China.
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky.
J Wrist Surg. 2013 May;2(2):155-9. doi: 10.1055/s-0033-1343079.
The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months. Paired t-tests were used preoperatively, one month after pin removal, and at final follow-up to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.
本研究的目的是检查腕背侧腕骨间韧带关节囊固定术（DILC）的影像学结果，记录术后腕骨塌陷的时间。2008年1月至2011年1月，确定了12例慢性舟月（SL）分离患者。平均随访期为15.8个月。在术前、拔针后1个月和最终随访时使用配对t检验来确定影像学结果的显著性。在手术前后对患者进行上肢、肩部和手部功能障碍（DASH）调查，以评估疼痛、功能和满意度的主观水平。术中所有畸形均完全矫正。拔针后1个月，平均SL间隙为3.3毫米，SL角为74°，桡月（RL）角为17°，月头（LC）角为8°。只有SL角有所改善；其他测量值保持不变。在最终随访时，平均SL间隙为3.6毫米，SL角为78°，RL角为20°，LC角为10°。SL角恶化，但无统计学显著差异。在最终随访时，其他影像学测量值保持不变。术后腕关节屈伸活动度从对侧的76%和69%降至对侧的62%和56%。术前握力为对侧的64%，术后为83%。视觉模拟评分（VAS）结果从6.3改善至1.7，术后DASH评分从39改善至8。DILC无法承受较大的重复性力量。DILC术后短时间内腕骨塌陷复发。然而，我们的患者数量较少且随访时间较短，无法就该手术的临床疗效得出任何结论。本研究的局限性包括这是一项无对照组的回顾性研究。此外，这是一个单术者系列研究，引入了偏倚来源，并存在技术和方法缺陷的风险，这可能导致了观察到的影像学结果。
