Effect of Capitolunate Positioning on Outcomes in Scaphoid Excision and 4-Bone Fusion Patients.

IF 1.8 Q2 ORTHOPEDICS HAND Pub Date : 2024-11-01 Epub Date: 2023-07-23 DOI:10.1177/15589447231187074
Cameron L Hallihan, Robert J Goitz, Robert A Kaufmann, John R Fowler
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Abstract

Background: Scaphoid excision and 4-bone fusion (4BF) is a surgical procedure to treat scapholunate advanced collapse. Some surgeons align the lunate over the capitates, whereas others leave the capitate in its uncovered native position. The capitolunate angle may affect long-term outcomes. This study examined whether postsurgical outcomes differed based on these differences in positioning.

Methods: A retrospective analysis was performed for patients that underwent a 4BF between 2006 and 2020. Wrist range of motion; pain (0-10); and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were recorded. The width of the capitate, the width of the lunate contacting the capitate, and the capitolunate angle were measured. Pearson correlations and t tests were performed. For t tests of capitolunate uncovering, patients were divided into 2 groups: patients with 0% capitate uncovering and patients with >0% uncovering. For capitolunate angle, the 2 groups were patients with a capitolunate angle of ≤10° and patients with a capitolunate angle of >10°.

Results: There was a significant correlation between capitate coverage and wrist extension, but no correlation for flexion, pain, or DASH scores. Group 1 (0% uncovering) had increased wrist extension and decreased pain compared with group 2 (>0% uncovering). There were no significant correlations or differences in the analyses of capitolunate angle's impact on outcomes.

Conclusions: In patients undergoing 4BF, those who had the lunate aligned to completely cover the capitate head had improved wrist extension and pain compared with patients where the capitate head was left partially uncovered. Capitolunate angle was not predictive of postsurgical outcomes.

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Capitolunate定位对肩胛骨切除术和4骨融合术患者疗效的影响
背景:肩胛骨切除和四骨融合术(4BF)是一种治疗肩胛骨晚期塌陷的手术方法。一些外科医生会将新月形骨对准肩胛骨,而另一些外科医生则会将肩胛骨保留在未覆盖的原位。肩胛骨角度可能会影响长期疗效。本研究探讨了手术后的疗效是否会因定位的不同而有所差异:对2006年至2020年间接受4BF手术的患者进行了回顾性分析。记录了腕关节的活动范围、疼痛(0-10 分)以及手臂、肩部和手部残疾(DASH)评分。此外,还测量了头骨宽度、月骨接触头骨的宽度以及头骨与月骨的夹角。进行了皮尔逊相关性和 t 检验。在对帽状腱膜揭露度进行 t 检验时,将患者分为两组:帽状腱膜揭露度为 0% 的患者和揭露度大于 0% 的患者。在帽状腱膜角度方面,分为帽状腱膜角度≤10°和帽状腱膜角度>10°两组:结果:头状角覆盖率与腕关节伸展有明显相关性,但与屈曲、疼痛或DASH评分无相关性。第一组(0% 覆盖率)与第二组(>0% 覆盖率)相比,腕关节伸展度增加,疼痛减轻。在分析帽状腱膜角度对疗效的影响时,没有发现明显的相关性或差异:结论:在接受4BF手术的患者中,与帽状头部分未被覆盖的患者相比,月骨对齐以完全覆盖帽状头的患者的腕关节伸展和疼痛均有所改善。帽状头角度并不能预测术后效果。
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来源期刊
HAND
HAND Medicine-Surgery
CiteScore
3.30
自引率
0.00%
发文量
209
期刊介绍: HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.
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