Pang Eric Quan, Douglass Nathan, Kamal Robin N
1 Stanford University, Department of Orthopaedic Surgery, Redwood City, CA, USA.
Hand (N Y). 2018 Jul;13(4):418-422. doi: 10.1177/1558944717709073. Epub 2017 May 19.
We examined the relationship between lunate morphology (type 1 without a medial facet; type II with a medial facet) and dorsal intercalated segmental instability (DISI) in patients with scapholunate ligament injuries. We tested the primary null hypothesis that there is no relationship between lunate morphology and development of DISI. Secondary analysis compared the agreement of classifying lunate morphology based on the presence of a medial lunate facet, capitate-to-triquetrum (CT) distance, and magnetic resonance imaging (MRI).
We performed a retrospective chart review of patients with known scapholunate ligament injuries from 2001 to 2016. Posterior-anterior radiographs and MRI, when available, were evaluated. CT distances were measured as a secondary classification method. DISI and scapholunate instability were determined as radiolunate angle >15° and scapholunate angle >60°, respectively. Differences between groups were determined using chi-square analysis with significance set at P < .05. Agreement between plain radiographs, MRI, and CT distance was calculated using the kappa statistic.
Our search found 58 of 417 patients who met inclusion criteria; 41 of 58 had type II and 17 of 58 had type I lunates. There was no significant difference between groups in regard to DISI or scapholunate instability. Subanalysis using MRI alone or correcting any discrepancy between plain film and MRI classification, using MRI as the standard, found no difference between groups in regard to DISI or scapholunate instability.
In patients with scapholunate ligament injuries, there are no differences in the development of DISI or scapholunate instability between patients with type I and type II lunates.
我们研究了舟月韧带损伤患者的月骨形态（I型无内侧关节面；II型有内侧关节面）与背侧插入节段性不稳定（DISI）之间的关系。我们检验了主要无效假设，即月骨形态与DISI的发生之间没有关系。次要分析比较了基于月骨内侧关节面的存在、头状骨至三角骨（CT）距离和磁共振成像（MRI）对月骨形态进行分类的一致性。
我们对2001年至2016年已知舟月韧带损伤的患者进行了回顾性病历审查。评估了前后位X线片和MRI（如有）。测量CT距离作为次要分类方法。分别将DISI和舟月关节不稳定定义为桡月角>15°和舟月角>60°。使用卡方分析确定组间差异，显著性设定为P <.05。使用kappa统计量计算X线平片、MRI和CT距离之间的一致性。
我们的检索发现417例患者中有58例符合纳入标准；58例中有41例为II型月骨，17例为I型月骨。两组在DISI或舟月关节不稳定方面没有显著差异。单独使用MRI或使用MRI作为标准校正X线平片和MRI分类之间的任何差异进行的亚分析发现，两组在DISI或舟月关节不稳定方面没有差异。
在舟月韧带损伤患者中，I型和II型月骨患者在DISI或舟月关节不稳定的发生方面没有差异。
