Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; Chirurgie de la main et plastique adulte, CHU Charles Nicolle, Rouen, France.
Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France.
J Plast Surg Hand Surg. 2024 May 20;59:77-82. doi: 10.2340/jphs.v59.18338.
Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures.
This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores.
Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12-132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group.
This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.
四角融合切除舟骨（FCA）和近排腕骨切除术（PRC）常用于治疗创伤后舟状骨非愈合性进展性塌陷（SNAC）/舟月骨进展性塌陷（SLAC）关节炎的手腕。本研究旨在比较这两种手术的临床结果。
这是一项单中心回顾性队列研究，纳入了 2009 年 1 月 1 日至 2019 年 1 月 1 日期间接受 PRC 或 FCA 并接受随访的所有患者。随访内容包括：活动度（桡偏、尺偏、屈、伸）、力量（握力测试、捏力测试）、功能（QuickDash、患者腕关节评估量表[PRWE]）、主观活动度和总体满意度评分。
25 例患者中，11 例接受 PRC，14 例接受 FCA，平均随访 69.5 个月[12-132]。桡偏度分别为 18°和 14°（p=0.7），尺偏度分别为 21°和 22°（p=0.15），掌屈度分别为 39°和 30°（p=0.32），背伸度分别为 32.5°和 29.5°（p=0.09），握力测试与对侧相比分别为 72%和 62%（p=0.53），QuickDash 评分分别为 12.5 和 17.6（p=0.84），PRWE 评分分别为 18.7 和 17.6（p=0.38），主观活动度评分分别为 7.8 和 7.5（p=0.23），满意度评分分别为 8.7 和 9（p=0.76），FCA 组和 PRC 组分别。FCA 组的再手术率为 14%，PRC 组为 0%。
本研究发现，对于创伤后 SLAC 或 SNAC Ⅱ期腕关节炎患者，FCA 和 PRC 在力量、活动度和功能方面无显著差异。FCA 和 PRC 似乎都是可靠的手术技术，FCA 组的翻修率更高，但结果良好。
