Shintani Kosuke, Kazuki Kenichi, Takamatsu Kiyohito, Yoneda Masahiro, Uemura Takuya
1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
2 Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan.
J Hand Surg Asian Pac Vol. 2016 Jun;21(2):207-11. doi: 10.1142/S242483551650020X.
Limited wrist arthrodesis with scaphoid excision is a useful treatment for scapholunate advanced collapse (SLAC) of the wrist. Multiple Kirschner wires were originally used for internal fixation of the four carpal bones, however long-term cast immobilization, pin tract infection, and hardware removal are still problematic. We introduce and evaluate the clinical outcomes of an internal fixation technique; triangle fixation for four-corner fusion, using three headless screws, as an alternative to conventional multiple Kirschner wires for the treatment of SLAC wrist.
Five male patients with SLAC wrist secondary to three scaphoid nonunions and two scapholunate dissociations were treated with four-corner fusion using triangle fixation with three Double-threaded Japan screws. The mean age was 59.5 years (35-79 years) and the mean follow-up period was 40 months. After surgery, short arm splints were applied for 3-4 weeks, and then range of motion exercises were initiated.
Wrist range of motion and grip strength both improved postoperatively. At the final follow-up evaluation, bone union was completely achieved and satisfactory pain relief was observed in all patients.
Compared with the conventional Kirschner wire technique, the present technique shortens the period of splint immobilization due to a strong compression force in a skewed position, does not require pin removal or cause pin tract infections, and provides satisfactory results.
舟骨切除的有限腕关节融合术是治疗腕关节舟月骨晚期塌陷（SLAC）的一种有效方法。最初使用多根克氏针来固定四块腕骨，然而长期的石膏固定、针道感染以及取出内固定装置仍然存在问题。我们介绍并评估一种内固定技术的临床效果；使用三颗无头螺钉进行四角融合的三角形固定，作为治疗SLAC腕关节的传统多根克氏针的替代方法。
五名男性患者，其中三名因舟骨不愈合、两名因舟月骨分离继发SLAC腕关节，采用三颗双螺纹日本螺钉进行三角形固定的四角融合术治疗。平均年龄为59.5岁（35 - 79岁），平均随访期为40个月。术后应用短臂夹板固定3 - 4周，然后开始进行活动度锻炼。
术后腕关节活动度和握力均有所改善。在最后一次随访评估时，所有患者均实现了骨愈合，且疼痛缓解情况令人满意。
与传统的克氏针技术相比，本技术由于在倾斜位置具有强大的压缩力，缩短了夹板固定时间，无需取出内固定针，也不会引起针道感染，且效果令人满意。
