舟骨切除头月融合和四角融合术治疗SLAC腕和SNAC腕临床效果的对比研究

Clinical outcomes of scaphoid excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis for SLAC and SNAC

目的比较舟骨切除头月关节融合术和舟骨切除四角融合术治疗舟月进行性塌陷(scapholunate advanced collapse,SLAC)和舟骨不愈合进行性塌陷(scaphoid non-union advanced collapse,SNAC)的临床效果。方法回顾分析2011年8月至2018年10月,应用舟骨切除头月关节融合术和舟骨切除四角融合术治疗的106例SLAC腕和SNAC腕的病例。其中81例获得完整的随访评估,包括SLAC腕26例和SNAC腕55例,均伴有严重腕痛、握力显著下降、腕关节功能受限。其中II期46例,III期35例。接受舟骨切除四角融合术的病例为32例,接受舟骨切除头月关节融合术的病例为49例。术后所有患者随访1.5~6.5年,平均3.5年。随访指标腕关节疼痛度(VAS评分)、腕关节活动度(屈伸,視尺偏,旋前旋后)、握力以及患侧X线检查。上肢功能评价使用DASH评分进行评估。结果头月关节融合组49例和四角融合组32例比较.术后腕关节疼痛程度、腕关节活动度、融合率和DASH评分差异均无统计学意义。头月关节融合组病例握力好于四角融合组。四角融合组有2例患者出现继发腕关节尺侧疼痛,2例患考出现不愈合。结论舟骨切除头月关节融合术和舟骨切除四角融合术均为治疗II期、III期SI.AC腕和SNAC腕可靠的挽救性手术,头月融合相对于四角融合手术更为简单,在获得相同融合率的前提下植骨量更少.术后握力恢复更好,术后继发腕关节尺侧疼痛的概率更低。

Objective To compare the clinical outcomes of scaphoid excision combined with capitolunate arthrodesis versus 4-corner(capitate,hamate,lunate,triquetrum)intercarpal arthrodesis for scapholunate advanced collapse(SLAC)and scaphoid non-union advanced collapse(SNAC).Methods From August 2011 to October 2018,106 patients after scaphoid excision with capitolunate arthrodesis and scaphoid excision and four-corner arthrodesis were retrospectively analyzed.55 patients of SNAC and 26 patients of SLAC were followed up for 1.5-6.5 years(mean:3.5 years),and all were accompanied by severe wrist pain,decreased grip strength,and loss of range of motion(ROM).There were 46 cases of phase II and 35 cases of phase III.Scaphoid excision with capitolunate arthrodesis was performed on 49 patients,while scaphoid excision with 4-comer arthrodesis on 32 patients.Wrist VAS,ROM(flexion-extension,radial-ulnar deviation,pronation-supination),grip strength and radiographs were recorded and analyzed.Disabilities of the Arm,Shoulder,and Hand(DASH)questionnaire was applied for evaluation.Results No significant differences in VAS,ROM,fusion rate and DASH were observed between the two groups.There was a slight increase in grip strength of the capitolunate arthrodesis group.Two patients with nonunion and 2 patients with secondary ulnar pain were noted in the four-comer arthrodesis group.Conclusions Scaphoid excision with capitolunate arthrodesis and 4-comer arthrodesis are similar salvage procedures for SNAC and SLAC at stage II and III.However,Scaphoid excision with capitolunate arthrodesis is recommended by its simple operation,lessened need of bone graft,better grip strength and lower incidence of ulnar pain.