Bain Gregory Ian, Sood Aman, Yeo Chong Jin
Shoulder and Upper Limb Surgeon, Private Practice, South Australia, Australia ; Department of Orthopaedics and Trauma, and Discipline of Anatomy and Pathology, University of Adelaide, South Australia, Australia ; Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, South Australia, Australia ; Department of Orthopaedics, Modbury Public Hospital, Adelaide, South Australia, Australia ; Orthopaedics SA, Adelaide, South Australia, Australia.
Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, South Australia, Australia ; Orthopaedics SA, Adelaide, South Australia, Australia.
J Wrist Surg. 2014 Feb;3(1):37-41. doi: 10.1055/s-0033-1364095.
Radioscapholunate (RSL) fusion has been utilized for treatment of radiocarpal arthritis for patients with an intact midcarpal joint. This preserves midcarpal joint motion while alleviating pain. Dart thrower's motion (DTM), which has been emphasized recently, is mainly a midcarpal joint motion. Question A cadaveric study was designed to measure and compare the range of motion (ROM) of the human wrist before and after an RSL fusion, followed by distal scaphoid excision, and finally excision of the triquetrum. Methods Twelve embalmed adult cadaveric upper limbs were assessed. The wrist motion was measured with an electrogoniometer. Measurements of the flexion-extension plane and radial-ulnar deviation plane were obtained for baseline after capsulotomy, after simulated RSL fusion with memory staples, after distal scaphoidectomy, and after excision of the triquetrum. Results The effects of scaphoid and triquetrum excision were expressed as improvements in movement over that of the preceding step. RSL fusion alone resulted in a decrease of the flexion-extension (F-E) arc by 36% and the radioulnar deviation (R-U) arc by 30%. Excision of the distal scaphoid with RSL improved the F-E arc by 34% and the R-U arc by 34%. With excision of the triquetrum, the F-E arc improved further by 13% and the R-U arc by 21%. The ROM of the simulated RSL fusion with distal scaphoidectomy is improved with excising the triquetrum, mainly through an increase in ulnar deviation motion. RSL fusion with distal scaphoidectomy and triquetrectomy can be an alternative to total wrist arthrodesis for patients with an intact midcarpal joint.
桡舟月融合术已被用于治疗腕中关节完整的桡腕关节炎患者。这在减轻疼痛的同时保留了腕中关节的活动度。最近备受关注的“投镖手动作”（DTM）主要是一种腕中关节动作。问题：设计了一项尸体研究，以测量和比较人手腕在桡舟月融合术、随后切除舟骨远端以及最后切除三角骨之前和之后的活动范围（ROM）。方法：评估了12具防腐处理的成年尸体上肢。使用电子角度计测量腕关节活动度。在关节囊切开术后、用记忆吻合钉模拟桡舟月融合术后、舟骨远端切除术后以及三角骨切除术后，获取屈伸平面和桡尺偏斜平面的基线测量值。结果：舟骨和三角骨切除的效果表现为相对于上一步骤运动的改善。仅桡舟月融合术导致屈伸（F-E）弧减少36%，桡尺偏斜（R-U）弧减少30%。桡舟月融合术联合切除舟骨远端使F-E弧改善了34%，R-U弧改善了34%。切除三角骨后，F-E弧进一步改善了13%，R-U弧改善了21%。切除三角骨可改善模拟桡舟月融合术联合切除舟骨远端后的ROM，主要是通过增加尺偏运动实现的。对于腕中关节完整的患者，桡舟月融合术联合切除舟骨远端和三角骨切除术可作为全腕关节融合术的替代方案。
