Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Medical Center East-South Tower, Nashville, TN, USA.
Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Medical Center East-South Tower, Nashville, TN, USA.
J Hand Ther. 2020 Jan-Mar;33(1):45-59. doi: 10.1016/j.jht.2018.09.005. Epub 2019 Mar 14.
Scoping review.
Dart thrower's motion (DTM) of the wrist primarily arises from the midcarpal joint, and minimizes stress to the scapholunate interosseous ligament (SLIL). After SLIL injury or surgery, early controlled DTM may reduce the effects of prolonged immobilization, while protecting SLIL integrity.
To summarize the literature on the effects of DTM on the injured and surgically repaired SLIL and the extent to which various DTM orthotic designs promote SLIL recovery.
A systematic literature search was conducted within 6 databases for articles published between 2003 and March 2018. Eligible studies examined DTM in the context of SLIL injury or repair. Relevant data were extracted by 2 independent reviewers.
Of 425 identified articles, 15 were eligible for inclusion. Five biomechanical studies examined the influence of DTM on the injured SLIL, whereas 5 articles described DTM orthotic designs. Also included were five articles that reported outcomes when DTM was used in the rehabilitation protocol.
The included studies suggest limiting end ranges of DTM in the injured/repaired SLIL, while blocking orthogonal plane movements. Custom orthotic designs may accomplish this goal. DTM has been used in comprehensive therapy programs in small case studies reporting short-term and intermediate clinical outcomes.
Caution should be exercised with using DTM on the torn SLIL as gap increases, particularly at the end-range motion. Orthosis designs have potential to limit this motion to midrange, while allowing early movement. Further high-level research is needed to understand the influence of DTM on injured and postsurgical populations.
范围综述。
腕部的掷镖者动作（DTM）主要源于腕中关节，可最大程度地减少对舟月骨间韧带（SLIL）的压力。SLIL 损伤或手术后，早期进行受控的 DTM 可能会减轻长时间固定的影响，同时保护 SLIL 的完整性。
总结关于 DTM 对受伤和手术修复的 SLIL 的影响的文献，并确定各种 DTM 矫形器设计在多大程度上促进 SLIL 恢复。
在 6 个数据库中进行了系统的文献检索，以查找 2003 年至 2018 年 3 月期间发表的文章。符合条件的研究检查了 DTM 在 SLIL 损伤或修复背景下的应用。由 2 位独立的审查员提取相关数据。
在 425 篇确定的文章中，有 15 篇符合纳入标准。五项生物力学研究检查了 DTM 对受伤的 SLIL 的影响，而 5 篇文章则描述了 DTM 矫形器设计。还包括五篇报告在康复方案中使用 DTM 时的结果的文章。
纳入的研究表明，在受伤/修复的 SLIL 中应限制 DTM 的末端范围，同时阻止正交平面运动。定制的矫形器设计可能可以实现这一目标。在小型病例研究中，DTM 已在综合治疗计划中使用，这些研究报告了短期和中期的临床结果。
对于撕裂的 SLIL，应谨慎使用 DTM，因为间隙会增大，尤其是在末端运动时。矫形器设计有可能将这种运动限制在中程范围内，同时允许早期运动。需要进一步进行高水平的研究，以了解 DTM 对受伤和手术后人群的影响。
