Divisions of Plastics and Orthopaedic Surgery, Toronto Western Hospital Hand Clinic, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Biomedical Engineering, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada.
J Hand Surg Am. 2021 Mar;46(3):244.e1-244.e11. doi: 10.1016/j.jhsa.2020.08.021. Epub 2020 Nov 6.
Reconstruction of the scapholunate ligament (SLL) in the setting of dynamic instability remains a surgical challenge, with lack of consensus on the best reconstructive procedure. Reconstruction of only the dorsal component may lead to volar gapping and abnormal wrist kinematics. This cadaveric active motion simulation study determined whether scapholunate (SL) motion, angulation, and contact are restored following open reconstruction using the extensor carpi radialis longus (ECRL) tenodesis, which reconstructs both the volar and the dorsal SLL components.
Seven fresh-frozen cadaveric upper limbs (mean age, 68 ± 10.1 years) underwent a 4-stage protocol of cyclic dart-throw motion and flexion-extension motion (utilizing an active wrist motion simulator that used tendon load/motion-controlled actuation. Scaphoid and lunate motion, relative scaphoid translation, SL angle, and dorsal-volar SL diastasis were measured with (1) wrist ligaments intact, (2) following complete sectioning of the SLL, and (3) following SL reconstruction using the ECRL tenodesis technique.
Complete SLL sectioning resulted in a typical pattern of SL instability. Following the ECRL tenodesis, lunate extension was not corrected. Scaphoid flexion, however, was not significantly different from the native state in FEM but remained significantly flexed during dart-throw motion. Differential dorsal and volar gapping did not significantly improve following ECRL tenodesis (dorsal, 1.2-2.3 mm; volar, 1.1-1.7 mm).
This biomechanical study demonstrates that the ECRL tenodesis did not fully restore native carpal kinematics, despite dorsal and volar SLL, and scaphotrapeziotrapezoid reconstruction.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
动态不稳定情况下的舟月韧带（SLL）重建仍然是一项外科挑战，对于最佳重建方法尚未达成共识。仅重建背侧成分可能导致掌侧间隙和异常腕关节运动学。本尸体主动运动模拟研究旨在确定桡侧腕长伸肌（ECRL）肌腱固定术（重建掌侧和背侧 SLL 成分）开放重建后是否能恢复 SL 运动、角度和接触。
7 例新鲜冷冻尸体上肢（平均年龄 68±10.1 岁）接受 4 个阶段的投掷运动和屈伸运动的循环方案（使用主动腕关节运动模拟器，该模拟器使用肌腱负载/运动控制驱动）。在（1）腕韧带完整，（2）完全切断 SLL 后，（3）使用 ECRL 肌腱固定术重建 SL 后，测量舟骨和月骨运动、相对舟骨平移、SL 角度和背-掌 SL 分离度。
完全切断 SLL 导致典型的 SL 不稳定模式。在 ECRL 肌腱固定术后，月骨伸展未得到纠正。然而，在 fem 中，与天然状态相比，舟骨屈曲并没有显著不同，但在投掷运动中仍保持明显的屈曲。背侧和掌侧间隙的差异在 ECRL 肌腱固定术后并没有显著改善（背侧 1.2-2.3mm；掌侧 1.1-1.7mm）。
这项生物力学研究表明，尽管进行了背侧和掌侧 SLL 以及舟骨大多角骨大多角骨重建，但 ECRL 肌腱固定术并未完全恢复正常的腕骨运动学。
类型的研究/证据水平：治疗 IV 级。
