Lamas Gomez Claudia, Proubasta Renart Ignacio, Llusa Perez Manuel
Orthopedics. 2015 Nov;38(11):e1040-5. doi: 10.3928/01477447-20151020-14.
The authors retrospectively studied 36 patients with degenerative changes associated with scaphoid nonunion and scapholunate advanced collapse treated with circular plate fixation and bone graft. The goals of the study were to review the incidence of dorsal impingement, nonunion of arthrodesis, loose hardware, broken screws, and limitation in wrist motion associated with correct or incorrect surgical capitolunate reduction. Surgical indications were scapholunate advanced collapse (3 patients), scaphoid nonunion advanced collapse (32 patients), and sequelae of irreducible perilunate dislocation (1 patient). All of the patients were men, with a mean age of 48 years (range, 35-68 years). Average follow-up was 56 months (range, 12-108 months). Functional outcomes evaluated were pain with the visual analog scale, range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, satisfaction, and time to union. Mean visual analog scale score was 7 (range, 5-9) preoperatively and 1 (range, 0-2) postoperatively. Average wrist range of motion was 42° in extension, 36° in flexion, 15° in ulnar deviation, and 12° in radial deviation. Mean grip strength was 34 kg preoperatively, 50 kg postoperatively, and 56 kg contralaterally. Thirty-five of the 36 patients achieved union at 6 months. Degenerative changes at the radiolunate articulation were present in 1 patient 62 months after surgery, but he was asymptomatic. Mean capitolunate angle was 38º preoperatively and 9º postoperatively. Poor correlation was found between the measured capitate-lunate angle and subsequent flexion and extension (r=0.32 and r=0.17, respectively) using the Pearson correlation coefficient. The authors noted 1 or 2 broken screws in 3 cases (8.3%) and hardware dorsal impingement in the plate in 6 cases (16.6%). Mean DASH score was 24 of 100. Overall patient satisfaction was 70%.
作者回顾性研究了36例因舟骨不愈合和舟月骨进行性塌陷而出现退行性改变，并接受环形钢板固定和植骨治疗的患者。本研究的目的是评估背侧撞击、关节融合不愈合、内固定松动、螺钉断裂以及与手术中头月关节复位正确与否相关的腕关节活动受限的发生率。手术指征为舟月骨进行性塌陷（3例）、舟骨不愈合伴进行性塌陷（32例）和不可复位的月骨周围脱位后遗症（1例）。所有患者均为男性，平均年龄48岁（范围35 - 68岁）。平均随访时间为56个月（范围12 - 108个月）。评估的功能结果包括视觉模拟量表疼痛评分、活动范围、握力、上肢、肩部和手部功能障碍（DASH）评分、满意度以及愈合时间。术前视觉模拟量表平均评分为7分（范围5 - 9分），术后为1分（范围0 - 2分）。腕关节平均活动范围为背伸42°、掌屈36°、尺偏15°和桡偏12°。术前平均握力为34kg，术后为50kg，对侧为56kg。36例患者中有35例在6个月时实现愈合。1例患者在术后62个月时，桡月关节出现退行性改变，但无症状。术前平均头月角为38°，术后为9°。使用Pearson相关系数发现，测量的头月角与随后的屈伸活动之间相关性较差（分别为r = 0.32和r = 0.17）。作者注意到3例（8.3%）出现1或2枚螺钉断裂，6例（16.6%）出现钢板内固定背侧撞击。DASH平均评分为100分中的24分。患者总体满意度为70%。
