Krakauer J D, Bishop A T, Cooney W P
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905.
J Hand Surg Am. 1994 Sep;19(5):751-9. doi: 10.1016/0363-5023(94)90178-3.
This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner arthrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Proximal row carpectomy was performed in 12 cases, radioscapholunate arthrodesis in 5 cases, radioscaphoid arthrodesis in 3 cases, and primary total wrist arthrodesis in 4 cases. Following surgical treatment the majority of patients in all groups had less wrist pain. The nonunion rate was four cases for the capitolunate arthrodesis group compared with two for the four-corner arthrodesis group. Six of 51 motion-sparing cases were converted to total arthrodeses. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with stage III SLAC wrist while maintaining a 54 degrees flexion-extension arc. Stage II SLAC wrist can be successfully treated with this procedure, radioscaphoid arthrodesis, or proximal row carpectomy. Of the three procedures, proximal row carpectomy best preserves wrist mobility, with a flexion-extension arc of 71 degrees.
本研究报告了55例II期和III期舟月关节进行性塌陷（SLAC）腕关节的六种不同重建手术的结果，平均随访50个月。31例行舟骨切除和腕骨间融合术：23例行四角融合术，8例行头月融合术。12例行近排腕骨切除术，5例行桡舟月融合术，3例行桡舟融合术，4例行一期全腕关节融合术。手术治疗后，所有组中的大多数患者腕部疼痛减轻。头月融合术组的骨不连率为4例，而四角融合术组为2例。51例保留运动功能的病例中有6例转为全关节融合术。舟骨切除和四角融合术能可靠地减轻III期SLAC腕关节患者的腕部疼痛，同时保持54度的屈伸弧度。II期SLAC腕关节可用此手术、桡舟融合术或近排腕骨切除术成功治疗。在这三种手术中，近排腕骨切除术最能保留腕关节活动度，屈伸弧度为71度。
