Duraku Liron S, Hundepool Caroline A, Hoogendam Lisa, Selles Ruud W, van der Heijden Brigitte E P A, Colaris Joost W, Hovius Steven E R, Zuidam J Michiel
From the Departments of Plastic, Reconstructive, and Hand Surgery, Orthopedic Surgery, and Rehabilitation Medicine, Erasmus Medical Center; Department of Plastic, Reconstructive, and Hand Surgery, Radboud Medical Center; Xpert Hand Clinic; and Department of Plastic, Reconstructive, and Hand Surgery, Jeroen Bosch Hospital.
Plast Reconstr Surg. 2022 Jun 1;149(6):1130e-1139e. doi: 10.1097/PRS.0000000000009116. Epub 2022 Apr 11.
Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis.
Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined.
A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups.
Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
腕中关节骨关节炎会导致手腕疼痛，严重影响生活，主要治疗方法是腕中关节融合术。公认的腕中关节融合术标准是四角融合，但最近，两角融合（即头月融合）越来越受欢迎。这是第一项比较头月融合与四角融合治疗腕中关节骨关节炎的前瞻性、多中心队列研究。
纳入2013年至2019年间接受头月融合或四角融合的舟骨不愈合伴晚期塌陷或舟月骨晚期塌陷2至3级的患者。共纳入63例患者（34例行头月融合，29例行四角融合）。两组患者的人口统计学特征相似。在基线、术后3个月和12个月测量患者自评腕手评估问卷评分、视觉模拟量表疼痛评分、握力、活动范围和并发症情况。确定并发症（即骨不连、内固定物移位、转为腕关节融合术或关节成形术）。
头月融合组和四角融合组术后3个月和12个月的患者自评腕手评估或视觉模拟量表疼痛评分无显著差异。术前及术后12个月，两组患者的握力无差异。术后12个月，头月融合组患者的屈曲度优于四角融合组（p = 0.002）；两组的并发症和再次手术率无差异。
头月融合和四角融合在功能评分（即患者自评腕手评估和视觉模拟量表疼痛评分）和并发症评分方面具有可比性。在治疗腕中关节骨关节炎方面，头月融合与四角融合相比，腕关节活动度更佳。头月融合的优势包括使用材料少、骨移植需求少以及固定时月骨复位更容易。
临床问题/证据水平：治疗性，II级。
