Scapholunate Kinematics After Combined Palmar and Dorsal Ligament Reconstruction: A Quantitative Evaluation Using Four-Dimensional Computed Tomography

IF 2.1 2区医学 Q2 ORTHOPEDICS Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2024.11.014

Merel J.-L. Berkhout MD, MA , Johannes G.G. Dobbe PhD , Paul W.M. Wilmer MD , Geert J. Streekstra PhD, MEng , Marco J.P.F. Ritt MD, PhD

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Abstract

Purpose

This observational pilot study investigated (1) carpal positioning in the neutral wrist pose, (2) the scapholunate (SL) rotation axis, (3) physiological SL motion, and (4) the SL distance after combined palmar and dorsal SL ligament reconstruction using quantitative four-dimensional computed tomography (4D-CT) imaging.

Methods

Six subjects were included, and 4D-CT images of both wrists were obtained. Kinematic parameters of the treated side were compared to those of the healthy contralateral side, which was used as the normal reference.

Results

Average follow-up was 18.3 months (range, 8–35). After surgery, an average residual rotational deviation of the scaphoid (10.0° flexion, 8.1° radial deviation, 7.1° pronation) and lunate (17.5° extension) at neutral position of the wrist was observed compared with the contralateral side. Scapholunate motion followed that of the healthy wrists, whereas SL motion of one untreated affected wrist deviated from normal. Scapholunate distance was on average 1.3 mm larger than in the healthy wrists during flexion-extension and radioulnar deviation.

Conclusions

Combined palmar and dorsal SL ligament reconstruction seems to restore wrist kinematics, although the neutral position of the scaphoid and lunate are not restored to normal.

Type of study/level of evidence

Therapeutic V.

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掌背韧带联合重建后舟月骨运动学：四维计算机断层定量评价

目的：采用定量四维计算机断层扫描（4D-CT）技术，研究(1)腕部中性体位时腕关节的定位，(2)腕月骨（SL）旋转轴，(3)腕月骨的生理运动，以及(4)掌背联合重建腕月骨韧带后的腕月骨距离。方法选取6例受试者，分别获取双腕关节的4D-CT图像。将治疗侧的运动参数与健康对侧的运动参数进行比较，作为正常参考。结果平均随访18.3个月（8 ~ 35个月）。手术后，与对侧相比，腕关节中性位置舟状骨（屈10.0°，桡侧8.1°，旋前7.1°）和月骨（伸17.5°）的平均残余旋转偏差。舟月骨运动遵循健康腕关节，而未治疗的受影响腕关节的左旋运动偏离正常。在屈伸和尺桡偏离时，舟月骨距离比健康腕关节平均大1.3 mm。结论掌背韧带联合重建似乎可以恢复腕关节的运动学，但舟状骨和月骨的中性位置并没有恢复正常。研究类型/证据水平

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.