镍钛记忆合金腕骨四角融合器应用于腕塌陷临床疗效:9~10年随访

Clinical efficacy of four-corner arthrodesis concentrator of nickel-titanium memory alloy for carpal collapse:9-10 years of follow-up

目的探讨镍钛记忆合金腕骨四角融合器(NiTi shape memory ally four-corner arthrodesis concentrator,NT-FCAC)在治疗腕塌陷的应用效果,报告9~10年随访疗效。方法选取32例因舟骨骨不连腕塌陷及舟月进行性腕塌陷应用NT-FCAC行四角融合并舟骨切除术治疗的患者,采用测角计测量腕关节活动度;Jammar测力计测量握力;术前及术后进行快速臂肩手功能障碍评分(Quick DASH)观察肢体功能恢复情况;疼痛视觉模拟评分(VAS)评估患者腕关节疼痛程度,腕关节前后位及侧位片观察腕骨融合率。结果术后3个月32例腕骨均获骨性愈合。随访9~10年,所有患者未出现严重手术并发症,腕关节活动范围达到健侧的60%以上,患手握力恢复至健侧的80.78%。VAS评分由术前(5.97±0.86)分减至末次随访(0.16±0.37)分;Quick DASH评分由术前(70.00±4.76)分降至末次随访(6.16±1.25)分。VAS及Quick DASH评分术前较术后各次随访均具有统计学差异(P<0.05)。结论应用NT-FCAC进行腕骨四角融合术,腕骨融合率高,能保存大部分腕关节功能,远期疗效好,适用于需四角融合的腕塌陷。

Objective To explore the application effect of NiTi shape memory ally four-corner arthrodesis concentrator(NT-FCAC) in the treatment of wrist collapse,and to report the efficacy of 9-10 years follow-up.Methods Thirty-two patients with four-corner arthrodesis and navicular osteotomy with NTFCAC were selected for treatment of wrist collapse due to navicular osteogenesis imperfecta and navicularmoon-progressive wrist collapse.Goniometer was used to measure the wrist joint mobility.Jammar dynamometer was used to measure the grip strength.Quick DASH(Quick Arm,Shoulder,Hand Dysfunction Score) was used to observe the recovery of the limb function before and after the operation,and Visual Analogue Score(VAS) was used to assess the degree of the patients' wrist pain.Anteroposterior and lateral radiographs of the wrist joint were taken to observe the rate of carpal arthrodesis.Results Bone healing was obtained in all 32 carpal bones at 3 months postoperatively.At 9-10 years of follow-up,all patients had no serious surgical complications,the range of motion of the wrist joint reached more than 60% of the healthy side,and the grip strength of the affected hand was restored to 80.78% of that of the healthy side.The VAS score was reduced from the preoperative score(5.97±0.86) to the final follow-up(0.16±0.37),the Quick DASH score was reduced from the preoperative score(70.00±4.76) to the final follow-up(6.16±0.37).There were statistical differences in the preoperative VAS and Quick DASH scores and the VAS and Quick DASH scores at each follow-up.Conclusions The application of NT-FCAC for four-corner arthrodesis of the carpal bones has a high rate of carpal fusion,preserves most of the functions of the carpal joints,and has a good long-term efficacy,which is suitable for carpal collapse that requires four-corner arthrodesis.