Reissner Lisa, Hensler Stefanie, Kluge Sebastian, Marks Miriam, Herren Daniel B
Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Teaching, Research and Development, Zurich, Switzerland.
J Hand Surg Am. 2018 May;43(5):487.e1-487.e6. doi: 10.1016/j.jhsa.2017.10.036. Epub 2017 Dec 14.
The objective was to investigate the clinical and subjective outcomes of patients after 4-corner arthrodesis (FCA) for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) and to analyze complications. Furthermore, we compared the long-term results of a first-generation nonlocking plate (Spider) and a plate with a locking screw design (Flower plate).
In a retrospective cohort study, we included 39 patients with stage II or III SLAC or SNAC who underwent FCA. Twenty wrists were treated with a nonlocking plate and 19 with a locking plate. Patients completed the Patient-Rated Wrist Evaluation (PRWE) and the Michigan Hand Outcomes Questionnaire (MHQ). Active range of wrist motion, radiological signs such as impingement, and signs of implant loosening and nonunion, as well as postoperative complications, were assessed.
After a median postoperative follow-up time of 4.1 years, the PRWE score was 18 and the total MHQ score 79. Patient-reported and clinical outcomes were similar for the 2 plate types. Wrists fixed with the nonlocking plate had more dorsal impingements and loosening than wrists fixed with a locking plate. One nonunion was noted in the nonlocking plate group, and a single case of implant failure was seen for each plate type. A total of 5 patients with a nonlocking plate incurred postoperative complications that required further medical treatment.
FCA for patients with stage II or III SLAC or SNAC yields positive clinical and subjective outcomes. Based on the high complication rate following FCA with a nonlocking plate, we no longer use this implant and recommend fixation with a locking screw plate.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在探讨四关节融合术（FCA）治疗舟月骨高级塌陷（SLAC）或舟骨不愈合高级塌陷（SNAC）患者的临床及主观疗效，并分析并发症。此外，我们比较了第一代非锁定钢板（Spider）和带锁定螺钉设计钢板（Flower钢板）的长期疗效。
在一项回顾性队列研究中，我们纳入了39例接受FCA治疗的II期或III期SLAC或SNAC患者。20例腕关节采用非锁定钢板治疗，19例采用锁定钢板治疗。患者完成了患者自评腕关节评估（PRWE）和密歇根手部结局问卷（MHQ）。评估腕关节活动度、撞击等影像学征象、植入物松动和骨不连征象以及术后并发症。
术后中位随访时间为4.1年，PRWE评分为18分，MHQ总分79分。两种钢板类型的患者报告结局和临床疗效相似。采用非锁定钢板固定的腕关节比采用锁定钢板固定的腕关节有更多的背侧撞击和松动。非锁定钢板组出现1例骨不连，每种钢板类型均有1例植入物失败病例。共有5例采用非锁定钢板的患者出现术后并发症，需要进一步治疗。
FCA治疗II期或III期SLAC或SNAC患者可产生积极的临床及主观疗效。基于FCA采用非锁定钢板后的高并发症发生率，我们不再使用这种植入物，并建议采用锁定螺钉钢板固定。
研究类型/证据水平：治疗性IV级。
