Trentadue Taylor P, Lopez Cesar, Breighner Ryan E, Fautsch Kalli, Leng Shuai, Holmes Iii David R, Moran Steven L, Thoreson Andrew R, Kakar Sanjeev, Zhao Kristin D
Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota.
Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota.
J Wrist Surg. 2023 Feb 9;12(3):248-260. doi: 10.1055/s-0042-1758159. eCollection 2023 Jun.
In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level IV, Case series.
在动力前期或动力期舟月（SL）不稳定时，标准诊断成像可能无法识别舟月骨间韧带（SLIL）损伤，从而导致检测和干预延迟。本研究描述了使用四维计算机断层扫描（4DCT）来识别早期SLIL损伤，并对受伤手腕进行术后1年的随访。
4DCT以高时间分辨率（66毫秒）获取一系列三维容积数据。4DCT衍生的关节运动学数据可作为韧带完整性的生物标志物。
本研究介绍了在一个包含两名参与者的病例系列中使用4DCT来评估单侧SLIL损伤术前和术后1年关节运动学的变化。患者接受掌侧韧带修复术，包括掌侧关节囊固定术和关节镜下背侧关节囊固定术。对未受伤、术前受伤和术后受伤（修复后）的手腕进行关节运动学比较。
4DCT检测到屈伸和桡尺偏斜过程中骨间距离的变化。一般来说，在屈伸和桡尺偏斜过程中，未受伤手腕的桡舟关节距离最大，而未受伤手腕的SL间隙距离在屈伸和桡尺偏斜过程中最小。
4DCT可洞察运动过程中的腕关节运动学。桡舟关节和SL间隙之间的距离可以显示为邻近图或简化的描述性统计数据，以便于手腕和时间点之间的比较。这些数据有助于了解骨间距离减小和腕骨间分离增加的关注区域。这种方法可能使外科医生能够评估：（1）运动过程中损伤是否可见；（2）手术是否修复了损伤；（3）手术是否恢复了正常的腕关节运动。
IV级，病例系列。
