Amer Kamil M, Thomson Jennifer E, Vosbikian Michael M, Ahmed Irfan
From the Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Ann Plast Surg. 2020 Dec;85(6):699-703. doi: 10.1097/SAP.0000000000002398.
Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC.
An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain.
Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3.
This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.
腕关节舟月骨高级塌陷（SLAC）是腕关节最常见的退行性关节炎模式之一。对于有症状的SLAC和影响桡舟关节的退行性疾病患者，有必要进行手术干预。这种疾病的保留运动功能重建和治疗最常用的方法包括四角融合术和近排腕骨切除术。本文的目的是进行系统的文献综述和荟萃分析，以确定四角融合术和近排腕骨切除术治疗SLAC的临床结果有何差异。
对PubMed、Embase、OVID和Cochrane图书馆进行电子文献检索，以确定评估四角融合术与近排腕骨切除术治疗SLAC临床结果的研究。主要结局指标包括屈伸活动范围、握力和疼痛程度。
八项研究共纳入311例患者，符合荟萃分析的纳入标准。我们的荟萃分析表明，与四角融合术相比，接受近排腕骨切除术的患者屈伸活动范围在统计学上显著增加6.2度，握力显著增加1.52%，疼痛程度降低0.3。
本研究表明，在比较研究中，近排腕骨切除术治疗SLAC比四角融合术有统计学差异。尽管这些差异具有统计学意义，但仍然非常小且缺乏临床相关性。本研究进一步支持这两种治疗方法在治疗该疾病方面是等效的。虽然不具有临床显著性，但与四角融合术相比，接受近排腕骨切除术治疗的患者活动范围增加、握力增加且疼痛减轻。这些发现的局限性在于可用研究数量较少以及研究之间的异质性增加。需要进一步研究来证实这些发现。
