Yao Yu-Cheng, Wang Jung-Pan, Huang Tung-Fu, Chang Ming-Chau, Huang Yi-Chao
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Feb;80(2):117-120. doi: 10.1016/j.jcma.2016.10.001. Epub 2016 Nov 10.
Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure.
We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22-68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion-extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded.
Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion-extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies.
Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists.
四角融合术是治疗舟骨不愈合晚期塌陷或舟月骨晚期塌陷性腕关节的晚期退行性骨关节炎的有效方法。然而，月头状骨融合术作为一种替代方法，具有软组织剥离少和手术时间短等优点。我们回顾了10例该手术的病例，以揭示其并发症发生率和临床结果。
我们回顾性分析了10例有症状的舟骨不愈合晚期塌陷或舟月骨晚期塌陷性腕关节患者，这些患者接受了舟骨切除的月头状骨融合术。平均随访时间为44.5个月（范围22 - 68个月）。通过X线片、活动范围（屈伸）、视觉模拟评分和梅奥腕关节评分进行临床评估。记录包括不愈合和植入物移位在内的并发症。
在这些患者中，8例影像学显示牢固愈合，其余2例出现骨吸收和植入物移位，需要进行翻修手术。视觉模拟评分从5.0降至1.1，屈伸弧度从61°增加到72.5°。梅奥腕关节平均评分为70分。结果显示与先前研究相似。
通过我们的调查和研究结果，我们得出结论，月头状骨融合术可以恢复功能且几乎无痛的腕关节。此外，这些结果在随访中得以维持，并发症发生率与先前研究相似。这些结果表明，对于腕关节晚期退行性骨关节炎，月头状骨融合术是四角融合术令人满意的治疗替代方法。
