Smith D K, An K N, Cooney W P, Linscheid R L, Chao E Y
Department of Orthopedics, Mayo Clinic/Mayo Foundation, Rochester, Minnesota 55905.
J Orthop Res. 1989;7(4):590-8. doi: 10.1002/jor.1100070418.
The effects of a scaphoid osteotomy on the kinematics of the carpal bones were determined in five cadaveric wrist specimens. Minute radiographic markers were inserted into the distal radius and selected carpal bones through limited arthrotomies between the intercarpal ligaments. Simultaneous biplanar radiographs were obtained in neutral and the extreme wrist positions of extension, flexion, radial deviation, and ulnar deviation, both before and after a scaphoid waist osteotomy. The positions of each of the carpal markers and their corresponding carpal bones were digitized for each wrist position , and a computer-assisted motion analysis was performed for each specimen before and after transverse scaphoid waist osteotomy. Following the osteotomy, there was a tendency for the scaphoid osteotomy to collapse into a dorsally angulated or "humpback collapse" deformity during each extreme wrist position. There was also multiplanar osteotomy site motion as well as complex collapse deformities of the midcarpal joint associated with loss of the mechanical tie-rod function of the scaphoid. These findings reveal the importance of the scaphoid in maintaining normal kinematics and the inherent instability of these fractures with loss of scaphoid integrity.
在五个尸体腕关节标本中确定了舟骨截骨术对腕骨运动学的影响。通过腕骨间韧带之间的有限关节切开术，将微小的放射学标记物插入桡骨远端和选定的腕骨。在舟骨腰部截骨术前和术后，在腕关节的中立位以及伸展、屈曲、桡偏和尺偏的极限位置获得双平面同步X线片。对每个腕关节位置的每个腕骨标记物及其相应腕骨的位置进行数字化处理，并对每个标本在舟骨腰部横向截骨术前和术后进行计算机辅助运动分析。截骨术后，在每个腕关节极限位置，舟骨截骨术有塌陷成背侧成角或“驼背塌陷”畸形的趋势。还存在多平面截骨部位运动以及与舟骨机械连杆功能丧失相关的腕中关节复杂塌陷畸形。这些发现揭示了舟骨在维持正常运动学中的重要性以及这些骨折因舟骨完整性丧失而固有的不稳定性。
