Goeminne Sofie, Lemmens Laura, Degreef Ilse
Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium.
J Wrist Surg. 2021 Oct 1;11(4):302-306. doi: 10.1055/s-0041-1735982. eCollection 2022 Aug.
Lunate morphology has been suggested to influence carpal kinematics. We investigate a possible relation between presence of a medial lunate facet and dorsal intercalated segment instability (DISI) of the wrist in patients with a scapholunate (SL) dissociation. We retrospectively reviewed patients diagnosed with SL dissociation between 2000 and 2017. Lunate morphology was categorized based on radiographs and magnetic resonance imaging (MRI), as type I or II according to Viegas and Galley. DISI was defined as radiolunate angle > 15 degrees and SL instability as SL angle > 60 degrees. SL distance > 3 mm was considered as widening and carpal height ratio < 0.5 was considered as carpal collapse. We used descriptive statistics to report on SL instability and DISI in patients with Viegas type I and type II lunates. We calculated kappa to determine agreement between radiographs and MRI and to determine inter- and intraobserver agreement. Of 119 patient files, 79 wrists met the inclusion criteria of which 25 were type I lunates and 54 type II. Similar spreading of the data of both groups was found regarding DISI, SL instability, and SL widening based on radiographic classification of the lunate, even after adding MRI findings. In the presence of carpal collapse, capitate-to-triquetrum distance was higher. We found a substantial inter- and intraobserver agreement for lunate classification. Our results suggest a similar prevalence of DISI deformity or enlarged SL angle in patients with type I or II lunate in presence of SL dissociation. The Viegas classification is a reliable and reproducible classification system. This is a Level III, cross-sectional study design.
有人认为月骨形态会影响腕关节的运动学。我们研究了舟月（SL）分离患者中月骨内侧小关节的存在与腕关节背侧插入节段不稳定（DISI）之间的可能关系。我们回顾性分析了2000年至2017年间被诊断为SL分离的患者。根据X线片和磁共振成像（MRI），按照维加斯（Viegas）和加利（Galley）的方法将月骨形态分为I型或II型。DISI定义为桡月角>15度，SL不稳定定义为SL角>60度。SL间隙>3mm被视为增宽，腕高比<0.5被视为腕关节塌陷。我们使用描述性统计方法报告维加斯I型和II型月骨患者的SL不稳定和DISI情况。我们计算kappa值以确定X线片和MRI之间的一致性，并确定观察者间和观察者内的一致性。在119份患者档案中，79个腕关节符合纳入标准，其中25个为I型月骨，54个为II型。基于月骨的X线分类，即使加入MRI结果后，两组在DISI、SL不稳定和SL增宽的数据分布上也相似。在存在腕关节塌陷的情况下，头状骨至三角骨的距离更高。我们发现观察者间和观察者内对月骨分类有高度一致性。我们的结果表明，在存在SL分离的情况下，I型或II型月骨患者中DISI畸形或SL角增大的患病率相似。维加斯分类是一个可靠且可重复的分类系统。这是一项III级横断面研究设计。
