Tielemans A, Van Innis F, Troussel S, Detrembleur C, Libouton X, Lequint T
Grand hôpital de Charleroi, Department of Orthopedics, Grand-Rue 3, 6000 Charleroi, Belgium; Cliniques universitaires Saint-Luc, Department of Orthopedics and Traumatology, Avenue Hippocrate 10, 1200 Brussels, Belgium.
Grand hôpital de Charleroi, Department of Orthopedics, Grand-Rue 3, 6000 Charleroi, Belgium.
Hand Surg Rehabil. 2017 Jun;36(3):186-191. doi: 10.1016/j.hansur.2017.01.005. Epub 2017 Apr 5.
We assessed the effect of four-corner intercarpal fusion with locking plate without bone graft on daily activities and pain in patients with stage II and III scapholunate advanced collapse and scaphoid nonunion. Twenty-one patients who underwent four-corner fusion with scaphoidectomy without bone graft were evaluated with the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Visual Analog Scale (VAS) pain scores before and 16 months after surgery. We also compared postoperative grip strength between the operated and the healthy side. A principal component analysis was used to establish the relationship between functional benefit, immobilization period and number of physiotherapy sessions. We compared our results with published data. VAS and QuickDASH scores improved significantly. Loss of strength was observed postoperatively. QuickDASH score improved the most with a short immobilization period. No significant difference was found relative to the literature for follow-up time, range of motion, grip strength and QuickDASH score. All patients had bone fusion after 1 year. Four-corner fusion with locking plate is a procedure that reduces pain and improves functional scores. Our results are equal to those reported in the literature with bone graft. The union rate seemed high despite the absence of bone graft but was only assessed by x rays. This study allowed us to establish a treatment guideline: a shorter immobilization leads to better recovery.
我们评估了采用锁定钢板进行四角腕骨间融合且不植骨对II期和III期舟月骨高级塌陷及舟骨不愈合患者日常活动和疼痛的影响。对21例行舟骨切除且不植骨的四角融合术患者，在术前及术后16个月采用手臂、肩部和手部功能障碍（QuickDASH）及视觉模拟评分法（VAS）疼痛评分进行评估。我们还比较了手术侧与健侧术后的握力。采用主成分分析来确定功能获益、固定期和物理治疗次数之间的关系。我们将结果与已发表的数据进行了比较。VAS和QuickDASH评分显著改善。术后观察到力量有所丧失。固定期短则QuickDASH评分改善最为明显。在随访时间、活动范围、握力和QuickDASH评分方面，与文献相比未发现显著差异。所有患者在1年后均实现骨融合。采用锁定钢板的四角融合术是一种能减轻疼痛并改善功能评分的手术方法。我们的结果与文献中报道的植骨结果相当。尽管未植骨，但骨愈合率似乎较高，不过仅通过X线进行了评估。本研究使我们能够制定一个治疗指南：较短的固定期可带来更好的恢复。
