Sikora Sheena K, Tham Stephen K, Harvey Jason N, Garcia-Elias Marc, Goldring Tony, Rotstein Andrew H, Ek Eugene T
Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.
Victorian Hand Surgery Associates, Melbourne, Victoria, Australia.
J Wrist Surg. 2019 Feb;8(1):61-65. doi: 10.1055/s-0038-1673344. Epub 2018 Oct 3.
Scapholunate instability (SLI) is the most common form of carpal instability. Early detection of SLI is imperative as early reconstructive procedures can potentially prevent the natural history of progressive degenerative arthritis. After wrist arthroscopy, magnetic resonance imaging (MRI) remains the next best noninvasive diagnostic option; however, access still remains costly and is often limited in many health care systems worldwide. In this article, we describe a novel device that allows for dynamic X-rays to be taken, accentuating the scapholunate (SL) widening. Twist X-ray views are generated by the patient clenching a device that combines the standard clenched fist views with ulnar deviation and supination. The test is easy to perform and functions by combining a higher grip force with the ulnar deviation and pronation effects of the extensor carpi ulnaris tendon, thus accentuating the SL gap in dynamic instability. We present a series of four patients with dynamic SLI and compare the findings of the Twist X-rays with conventional wrist X-rays series, including standard anteroposterior, lateral, radial, and ulna deviation, clenched fist, and pencil grip views. In all the four patients, there was substantial dynamic SL widening. The SL interval increased from a mean of 1.8 mm (range: 1.5-2.8) on posteroanterior X-rays to 6.3 mm (range: 4.6-8.2) with the Twist views. Interestingly, on the pencil grip view, the mean widening was only 1.5 mm (range: 1-2.8 mm). The authors describe a novel device that allows for improved detection of dynamic SL ligament instability when performing stress X-ray views of the wrist. This is a Level IV study.
舟月关节不稳（SLI）是腕关节不稳最常见的形式。早期发现SLI至关重要，因为早期重建手术有可能预防进行性退行性关节炎的自然病程。腕关节镜检查后，磁共振成像（MRI）仍然是次优的非侵入性诊断选择；然而，其检查费用仍然高昂，并且在全球许多医疗保健系统中往往受到限制。在本文中，我们描述了一种新型装置，该装置能够进行动态X线检查，突出舟月（SL）间隙增宽。 “扭转”X线视图是通过患者紧握一种将标准握拳视图与尺偏和旋后相结合的装置而产生的。该检查易于实施，其原理是将更大的握力与尺侧腕伸肌腱的尺偏和旋前作用相结合，从而在动态不稳时突出SL间隙。 我们展示了一系列4例动态SLI患者，并将“扭转”X线检查结果与传统腕关节X线系列检查结果进行比较，传统腕关节X线系列检查包括标准前后位、侧位、桡偏和尺偏、握拳以及铅笔握视图。 在所有4例患者中，均存在明显的动态SL间隙增宽。SL间隙在前后位X线片上的平均宽度为1.8 mm（范围：1.5 - 2.8 mm），而在“扭转”视图下增加至6.3 mm（范围：4.6 - 8.2 mm）。有趣的是，在铅笔握视图下，平均增宽仅为1.5 mm（范围：1 - 2.8 mm）。 作者描述了一种新型装置，该装置在进行腕关节应力X线检查时能够更好地检测动态SL韧带不稳。 这是一项IV级研究。
