Traverso Purnell, Wong Anselm, Wollstein Ronit, Carlson Lois, Ashmead Duffield, Watson H Kirk
1 The Hand Center, Glastonbury, CT, USA.
2 Technion-Israel Institute of Technology, Haifa, Israel.
Hand (N Y). 2017 Nov;12(6):568-572. doi: 10.1177/1558944716681949. Epub 2016 Dec 5.
Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function.
A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification.
Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction.
Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.
腕关节舟月骨晚期塌陷（SLAC）是腕关节最常见的退行性病变。四角融合术（4CF）作为挽救性手术进行，但其长期效果的信息有限。我们假设4CF是一种具有良好临床长期功能的持久手术。
对接受4CF手术的患者进行回顾性病历审查，并获取访谈和近期X线片。排除随访期少于10年的患者。长期评估包括标准腕关节X线片、腕关节活动范围以及上肢、肩部和手部快速残疾问卷（QuickDASH）。X线片采用Kellgren-Lawrence分类法进行评估和描述。
1982年至2003年，489例腕关节因SLAC腕关节接受了4CF手术。12例患者（15个腕关节）可供随访。手术时的平均年龄为49.1岁（范围25 - 67岁）。术后平均随访18年（11 - 27年）。13个腕关节的病因是舟月骨晚期塌陷，2个腕关节是舟骨不愈合晚期塌陷。平均屈伸弧为68.6°（0° - 96°），桡尺偏弧为32.9°（0° - 5°）。QuickDASH评分平均为7.8（范围0 - 32.5），只有1个评分高于16。73%的X线片显示轻度至中度关节破坏，27%显示重度关节破坏。
舟骨切除和4CF对于晚期腕关节炎患者仍然是一种可靠的手术方法。尽管73%的患者桡月关节有影像学改变，但长期随访的功能结果良好。患者满意度高，功能障碍低。
