Kirschenbaum D, Schneider L H, Kirkpatrick W H, Adams D C, Cody R P
Department of Orthopaedic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Am. 1993 Sep;18(5):780-5. doi: 10.1016/0363-5023(93)90042-2.
Eighteen patients with symptomatic radioscaphoid arthritis had scaphoid excision and capitolunate arthrodesis. Eight patients also had a silicone scaphoid replacement. The follow-up period averaged 3 years. Fusion was solid in 12 cases at an average of 8 weeks, and pain was significantly less at follow-up evaluation. Six patients had a pseudarthrosis and five had persistent pain. Immobilization in the pseudarthrosis group averaged 6 weeks, which was significantly less than the group that fused. Two patients underwent successful repeat fusions. Wrist extension averaged 26 degrees, flexion 34 degrees, radial deviation 11 degrees, and ulnar deviation 24 degrees. Grip strength averaged 25 kg. Presence of an implant had no significant effect on motion or strength. Pin track infection and pseudarthrosis were the main complications. Pain relief, functional motion, good strength, and patient satisfaction can be expected after scaphoid excision and solid capitolunate arthrodesis. Kirschner wires should be buried subcutaneously to avoid infection. The addition of a scaphoid implant offered no advantage over simple scaphoid excision.
18例有症状的桡舟关节关节炎患者接受了舟骨切除和头月关节融合术。8例患者还进行了硅胶舟骨置换。随访期平均为3年。12例患者平均在8周时实现了牢固融合，随访评估时疼痛明显减轻。6例患者出现假关节，5例患者持续疼痛。假关节组的固定平均为6周，明显短于融合组。2例患者再次融合成功。腕关节伸展平均为26度，屈曲为34度，桡偏为11度，尺偏为24度。握力平均为25千克。植入物的存在对活动度或力量没有显著影响。针道感染和假关节是主要并发症。舟骨切除和牢固的头月关节融合术后有望实现疼痛缓解、功能活动良好、力量恢复以及患者满意。克氏针应埋于皮下以避免感染。与单纯舟骨切除相比，增加舟骨植入物并无优势。
