Said Joseph, Baker Kevin, Fernandez Laviel, Komatsu David E, Gould Elaine, Hurst Lawrence C
1 Stony Brook University Hospital, NY, USA.
Hand (N Y). 2018 Nov;13(6):671-677. doi: 10.1177/1558944717729219. Epub 2017 Sep 6.
Lack of a universally accepted location and normal value limits the utility of measuring scapholunate diastasis. The primary purpose of this study was to define the optimal location to measure the scapholunate gap throughout sequential ligament transections. Secondary purposes were to compare plain radiographs with fluoroscopy and to evaluate interrater reliability in measuring scapholunate diastasis.
Five cadaver forearms were imaged with intact carpal ligaments and after sequentially transecting the scapholunate, radioscaphocapitate, and scaphotrapezium-trapezoid ligaments. Plain radiographs and static fluoroscopic images were obtained with wrists in neutral and 30° ulnar deviation for each stage. Multiple reviewers performed measurements of the scapholunate interval at 3 separate locations. Mean distances were calculated and pairwise comparisons between groups were made. Intraclass correlation was calculated to determine interrater reliability.
Overall, measurements made in the middle of the scapholunate joint had the smallest margins of error for all imaging modalities, ligament disruptions, and wrist positions. For normal wrists, the mean scapholunate measurements were all less than 2.0 mm at the middle of the joint, regardless of imaging modality or wrist position. Fluoroscopy detected significance between more stages of instability than plain radiographs at the middle of the joint.
Measurements in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions. Measurements less than 2.0 mm at the middle of the scapholunate interval may be considered within normal range.
缺乏普遍接受的测量舟月间隙的位置和正常值限制了舟月分离测量的实用性。本研究的主要目的是确定在连续韧带横断过程中测量舟月间隙的最佳位置。次要目的是比较X线平片与透视检查，并评估测量舟月分离时观察者间的可靠性。
对5具尸体前臂进行成像，包括腕关节韧带完整时以及依次横断舟月韧带、桡舟头韧带和舟大多角-小多角韧带后。在每个阶段，分别在腕关节中立位和尺偏30°时获取X线平片和静态透视图像。多位观察者在3个不同位置测量舟月间隙。计算平均距离，并进行组间两两比较。计算组内相关系数以确定观察者间的可靠性。
总体而言，在舟月关节中部进行的测量对于所有成像方式、韧带损伤和腕关节位置的误差范围最小。对于正常腕关节，无论成像方式或腕关节位置如何，关节中部的舟月间隙平均测量值均小于2.0mm。在关节中部，透视检查比X线平片能检测到更多阶段的不稳定差异。
在透视成像下，腕关节中立位和尺偏30°时在舟月关节中部进行测量能最佳地捕捉韧带损伤的所有阶段。舟月间隙中部测量值小于2.0mm可认为在正常范围内。
