Kamrani Reza Shahryar, PanjaviLee Behnam, Vahedi Ehsan
Department of Orthopedics, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
J Hand Surg Asian Pac Vol. 2019 Dec;24(4):440-446. doi: 10.1142/S2424835519500565.
Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.
舟月骨分离（SLD）是一种常见的、有时会导致手腕功能障碍的韧带损伤。治疗的目的是恢复腕骨排列并防止关节退变。在本研究中，我们报告了使用缝线锚钉在舟月界面固定技术的中期结果。2011年至2016年，9名平均年龄为35岁的男性患者因慢性、有症状的动态或可复位的静态舟月骨分离接受了舟月缝线锚钉固定（SLAF），平均随访36个月。在腕背侧暴露后，将一枚2.8毫米的缝线锚钉插入月骨背侧近端外侧关节面。缝线的两端穿过舟骨内两条发散的骨管。在恢复舟月排列后，将缝线在骨结节上方打结。两根克氏针维持舟月和舟头状骨（SC）排列8周。测量影像学参数、腕关节活动范围和握力。使用Quick-DASH和改良梅奥腕关节评分（MMWS）评估功能结果。握力和被动活动分别达到对侧的75%和88%。术前、拔针后及随访应力位X线片上舟月间隙分别为5.4毫米、2.6毫米和3.4毫米。在任何时间点，舟月角分别为82度、-52度和65度。平均Quick-DASH评分从60分提高到25分。根据MMWS评分，1例为优，1例为良，5例为中，2例为差。SLAF是一种软组织操作最少的简单技术，能够矫正并维持腕骨排列，中期结果良好。
