带锁H型钛板四角融合治疗腕进行性塌陷的临床疗效

Four-corner arthrodesis of capitate;lunate;triquetrum and hamate with H type titanium plate for the treatment of carpal collapse： clinical efficacy analysis

目的探讨采用带锁H型钛板行腕骨间四角融合联合舟骨切除治疗腕塌陷的临床疗效。方法自2010年5月至2015年6月，我们采用带锁H型钛板行头、月、三角及钩骨四角融合并舟骨切除术治疗12例腕塌陷患者。腕塌陷原因：陈旧性舟骨骨折不愈合6例，陈旧性经舟骨月骨周围脱位5例，舟骨月骨进行性腕塌陷1例。根据术后患手使用情况、腕关节活动度、握力、静息和用力后腕关节疼痛程度等方面对手术疗效进行评价。结果术后随访时间为8～37个月，平均22个月，术后患手平均握力为（33．5±6．5）妇，恢复至健侧的79％g腕关节活动范围达到健侧的50％以上，患腕关节疼痛明显缓解，未出现骨不连及伤口感染等并发症。结论应用带锁H型钛板行头、月、三角及钩骨四角融合固定可靠，融合率高，能够保存大部分腕关节功能，是治疗腕塌陷的有效办法。

Objective To investigate the clinical efficacy of four-corner arthrodesis with H type titanium plate combined with scaphoid resection in the treatment of carpal collapse. Methods From May 2010 to June 2015, 12 patients with carpal collapse were treated by four-comer arthrodesis of capitate, lunate, triquetrum and hamate with H type titanium plate combined with scaphoid resection. The causes of carpal collapse included nonunion old scaphoid fracture in 6 cases, old trans-scaphoid perilunar dislocation in 5 cases and scapholunate advanced collapse in 1 case. The clinical efficacy evaluation included hand using condition, wrist movement, hand grip strength, the degree of wrist pain after resting or exerting force. Results The follow-up time ranged from 8 to 37 months with an average of 22 months. The postoperative hand grip strength averaged （33.5±6.5） kg （79% of the healthy side）. The range of the wrist movement reached more than 50% of the healthy side. The wrist pain relieved obviously, and no complications such as bone nonunion and wound infection occurred. Conclusion The application of four-comer arthrodesis of capitate, lunate, triquetmm and hamate with H type titanium plate can save most of the wrist joint function with reliable fixation and high rate of fusion, which is an effective method for the treatment of carpal collapse.