Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia.
Flinders University, Adelaide, South Australia, Australia.
J Hand Surg Eur Vol. 2023 Mar;48(3):257-268. doi: 10.1177/17531934221148009. Epub 2023 Feb 17.
The wrist is a universal joint with intrinsic and extrinsic ligaments that function and fail as ligamentous complexes. Those related to scapholunate instability (SLI) include the dorsal scapholunate complex (DSLC), volar radiolunate complex and scaphotrapeziotrapezoid complex. Together the DSLC, scaphoid and lunate create an 'acetabulum' for the capitate, with the dorsal intercarpal ligament being a labrum to contain the capitate. SLI results from failure of the DSLC, typically from its scaphoid attachments. Failure of the lunate and or triquetral attachments increases the instability. DSLC failure leads to radioscaphoid instability, which is the symptomatic clinical problem. SLI reconstruction with open surgery and trans-osseous tendon graft techniques have been challenging. We discuss a biological arthroscopic approach to identify, mobilize and debride the disrupted DSLC. This ligament/capsular/periosteum sheet is then advanced and secured to the debrided footprint. Thereby reconstituting the acetabulum, labrum and scaphoid stability.
腕关节是一个具有内在和外在韧带的万向关节，这些韧带作为韧带复合体发挥作用或失效。与舟月不稳定（SLI）相关的包括背侧舟月复合体（DSLC）、掌侧桡月复合体和舟月三角骨复合体。DSLC、舟骨和月骨一起为头状骨形成一个“髋臼”，背侧腕骨间韧带是容纳头状骨的半月板。SLI 是由于 DSLC 的失效引起的，通常是由于其舟骨附着处的失效。月骨和/或三角骨附着处的失效会增加不稳定性。DSLC 失效导致桡骨腕骨不稳定，这是有症状的临床问题。开放式手术和经骨肌腱移植技术的 SLI 重建具有挑战性。我们讨论了一种生物关节镜方法来识别、动员和清创破坏的 DSLC。然后将这个韧带/囊/骨膜片推进并固定在清创后的足印处。从而重建髋臼、半月板和舟骨稳定性。
