Chenoweth Brian A, O'Mahony Gavin D, Fitzgerald Casey, Stoner Julie A, O'Donoghue Daniel L, Rayan Ghazi M
Department of Orthopedic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, OK.
University of Oklahoma Health Sciences Center, Oklahoma City, OK.
J Hand Surg Am. 2017 Jan;42(1):e25-e31. doi: 10.1016/j.jhsa.2016.11.007.
To test the biomechanical properties of the dorsoradial capsulodesis procedure.
Six cadaveric hands were used. After exposing the trapeziometacarpal (TMC) joint, we placed Kirschner wires in the distal radius and thumb metacarpal. The rotation shear test was then performed to test the joint axial laxity, and angular measurements using Kirschner wires as reference points were documented. The dorsoradial (DR) ligament and capsule were released, followed by the intermetacarpal (IM) ligament; angular measurements were obtained. Finally, the DR capsulodesis procedure was performed, and final measurements were obtained. Comparisons were made among the various stages of ligament integrity to determine the amount of stability provided by DR capsulodesis.
All cadavers demonstrated axial laxity with transection of the DR ligament; an increase in stability was obtained after DR capsulodesis. Transection of the capsule and IM ligament caused increased laxity relative to the native joint (median, 24° and 35°, respectively, on rotational testing). After we performed DR capsulodesis, rotational stability improved by a median of 41° compared with DR ligament transection, 49° compared with DR and IM ligament transection, and 18° relative to the native joint.
Dorsoradial capsulodesis restores rotational stability for TMC joint after division of the DR and IM ligaments. The stability achieved was statistically significant compared with both an intact native TMC joint and induced laxity of the TMC joint.
The DR capsulodesis procedure may improve rotational stability to the TMC joint.
测试桡背侧关节囊固定术的生物力学特性。
使用六具尸体手。暴露大多角骨-第一掌骨（TMC）关节后，在桡骨远端和拇指掌骨中置入克氏针。然后进行旋转剪切试验以测试关节轴向松弛度，并记录以克氏针为参考点的角度测量值。松解桡背侧（DR）韧带和关节囊，随后松解掌骨间（IM）韧带；获取角度测量值。最后，实施DR关节囊固定术，并获得最终测量值。对韧带完整性的各个阶段进行比较，以确定DR关节囊固定术提供的稳定程度。
所有尸体在DR韧带横断后均表现出轴向松弛；DR关节囊固定术后稳定性增加。与正常关节相比，关节囊和IM韧带横断导致松弛度增加（旋转测试时，中位数分别为24°和35°）。实施DR关节囊固定术后，与DR韧带横断相比，旋转稳定性中位数提高了41°，与DR和IM韧带横断相比提高了49°，相对于正常关节提高了18°。
桡背侧关节囊固定术在DR和IM韧带切断后可恢复TMC关节的旋转稳定性。与完整的正常TMC关节和诱导的TMC关节松弛相比，所实现的稳定性具有统计学意义。
DR关节囊固定术可能会改善TMC关节的旋转稳定性。
