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Retinaculum Grafts in Scapholunate Ligament Reconstruction: A Systematic Review 肩胛韧带重建中的网状移植:系统回顾
IF 0.7 Pub Date : 2024-06-04 DOI: 10.1055/s-0044-1787180
Lea Estermann, Melodi Yong, Blair S. York, Christopher Y. Tham, James Onggo, S. Tham
Background Several surgical techniques for the treatment of the irreparable chronic scapholunate (SL) ligament disruption, without arthritis, have been described using tendon grafts. An alternative technique is the use of retinaculum grafts. A systematic review of the biomechanical and histological properties of the bone–retinaculum–bone (BRB) graft and the clinical results of its use in SL ligament reconstruction was performed. Materials and Methods After abstract screening of 353 articles, a total of eight studies (five laboratory and three clinical) were included. Results Five cadaveric studies showed a lower load to failure and lower stiffness of the BRB compared with the scapholunate interosseous ligament. In patients with dynamic SL instability, treatment with BRB graft resulted in pain relief and an improvement in grip strength but with a reduced range of motion. Radiologically, no SL widening was found 18 months after surgery but with a slight increase after 12 years. The three clinical studies in this review have a level of evidence of 4. There were no studies on graft incorporation and remodeling. Conclusion There is insufficient clinical, histological, and biomechanical data available on the use of BRB grafts for SL ligament reconstruction.
背景介绍 有几种手术方法可以使用肌腱移植物治疗不可修复的慢性肩胛韧带(SL)断裂,但不伴有关节炎。另一种技术是使用韧带移植物。本研究对骨-retinaculum-骨(BRB)移植的生物力学和组织学特性及其在 SL 韧带重建中的临床效果进行了系统性回顾。材料与方法 经过对 353 篇文章的摘要筛选,共纳入 8 项研究(5 项实验室研究和 3 项临床研究)。结果 五项尸体研究显示,与肩胛骨骨间韧带相比,BRB 的破坏载荷更低,硬度更低。对于有动态SL不稳定性的患者,使用BRB移植治疗可缓解疼痛,改善握力,但活动范围减小。从放射学角度看,术后 18 个月未发现 SL 增宽,但 12 年后略有增加。本综述中的三项临床研究的证据等级为 4。结论 关于使用 BRB 移植物重建 SL 韧带的临床、组织学和生物力学数据尚不充分。
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引用次数: 0
Topology-Optimized Splints: A Novel Approach for Management of Distal Radial Fractures 拓扑优化夹板:治疗桡骨远端骨折的新方法
IF 0.7 Pub Date : 2024-06-04 DOI: 10.1055/s-0044-1787182
Muhammad Talha, Muhammad Hamza Awais Khalid
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引用次数: 0
Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury 外伤性尺侧腕关节移位、桡骨远端关节脱位伴隐性腕周损伤
IF 0.7 Pub Date : 2024-04-24 DOI: 10.1055/s-0044-1786160
Timothy Visser, Mikayla Borusiewicz, A. Payatakes
Background Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries. Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory. Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries. Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.
背景月骨周围损伤给治疗带来了巨大挑战,尤其是在最初被漏诊或低估的情况下。由于损伤可能通过韧带和/或骨骼传播,因此这些损伤有多种变异,最近人们对非脱位性舟骨周围损伤有了更多的认识。病例描述 我们介绍了一种新的非脱位性臼齿周围损伤(PLIND)。这种隐匿性韧带性月骨周围损伤伴有尺侧腕关节移位、桡侧腕关节半脱位和桡侧远端半脱位。损伤程度在术中得到了充分认识,术前检查和影像学检查仅发现了一些细微的线索,这强调了识别此类损伤所需的高度怀疑指数。1 年随访的临床结果非常令人满意。文献综述 PLIND 是髋臼周围损伤中的一个独特的子集,其中没有观察到髋臼关系的破坏。根据文献中报道的少数病例(由于其罕见的发生率,以及可能缺乏对这种损伤模式的认识),目前的手术治疗建议包括关节镜或开放式方法,以适当处理骨性和韧带损伤。临床意义 由于月骨上的头状头没有像典型的perilunate损伤那样发生明显脱位,因此识别PLIND损伤具有挑战性。对机制和表现一致的患者加强临床怀疑,并及时进行手术治疗,可减少持续不稳和关节炎的后遗症。我们的病例是以前未曾描述过的PLIND变异型,合并有桡骨不稳、尺侧腕骨移位和桡侧远端脱位,为相关文献做出了贡献。
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引用次数: 0
The Natural History of Non-operatively Treated Traumatic Triangular Fibrocartilage Complex Tears: A Systematic Review 非手术治疗创伤性三角纤维软骨复合体撕裂的自然史:系统回顾
IF 0.7 Pub Date : 2024-04-24 DOI: 10.1055/s-0044-1786164
Seung Il Choi, Simon MacLean, Shabhaz Malik
Purpose Operative treatment of triangular fibrocartilage complex (TFCC) tears has been well researched; however, data regarding nonoperative management is mixed and scarce. Our review aimed to utilize available data to formulate conclusions regarding treatment algorithms for this heterogeneous injury group. Methods A thorough literature review was performed in Medline (OVID), Embase, Cochrane Library, and PubMed databases with search terms including “triangular fibrocartilage complex” and variations on the full term including “triangular fibrocartilage” or “TFCC,” alongside “non-operative” and “conservative.” Results were then subject to inclusion criteria, ultimately identifying eight studies. Results The studies involved a total of 425 patients and 427 wrists for analysis. The mean age ranged from 30.7 years to 60.4 years. 53.6% of patients were male. The mean follow-up ranged from 12 months to 7 years, with an overall mean follow-up period of 27 months. Primary endpoints focused on various functional outcome scores, range of motion, grip strength, and pain. The nonoperative management of TFCC tears resulted in noninferior and comparable outcomes to operative management. Conclusion Our review identified that the nonoperative management of Palmer-type IB tears with a short period of above-elbow immobilization was an effective treatment option with good functional outcome scores. The nonoperative management of general TFCC tears resulted in comparable functional outcomes when viewed alongside results from other systematic reviews. Risk factors for developing a poor functional outcome or requiring operative management included distal radioulnar joint subluxation, short-arm immobilization, and full tears of the foveal attachment. However, further randomized controlled trials with homogenous data collection are required to make further conclusions regarding the management of this condition.
目的 对三角纤维软骨复合体(TFCC)撕裂的手术治疗进行了深入研究;然而,有关非手术治疗的数据却参差不齐,非常稀少。我们的综述旨在利用现有数据,为这一异质性损伤组的治疗算法得出结论。方法 在 Medline (OVID)、Embase、Cochrane Library 和 PubMed 数据库中进行了全面的文献综述,检索词包括 "三角纤维软骨复合体 "和全词的变体,包括 "三角纤维软骨 "或 "TFCC",以及 "非手术 "和 "保守"。然后对结果进行纳入标准,最终确定了八项研究。结果 这些研究共分析了 425 名患者和 427 只手腕。平均年龄从 30.7 岁到 60.4 岁不等。53.6%的患者为男性。平均随访时间从 12 个月到 7 年不等,总体平均随访时间为 27 个月。主要终点集中在各种功能结果评分、活动范围、握力和疼痛。TFCC撕裂的非手术治疗结果与手术治疗结果不相上下。结论 我们的研究发现,对帕尔默IB型撕裂进行短期肘部以上固定的非手术治疗是一种有效的治疗方案,并能获得良好的功能结果评分。与其他系统综述的结果相比,对一般 TFCC 撕裂进行非手术治疗的功能效果相当。功能结果不佳或需要手术治疗的风险因素包括:桡侧远端关节半脱位、短臂固定和眼窝附件完全撕裂。不过,还需要进一步进行随机对照试验,收集同质数据,才能对这种情况的治疗做出进一步的结论。
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引用次数: 0
Cuboid Bone for Distal Radius Reconstruction: An Anatomical Cadaver Study 用于桡骨远端重建的立方体骨:尸体解剖研究
IF 0.7 Pub Date : 2024-04-16 DOI: 10.1055/s-0044-1786031
Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, Alfonso Valverde-Navarro, A. Thione
Background The cuboid bone (CB) of the foot has been suggested as a potential source of autologous reconstruction of the distal radius (DR). This study sought to examine the feasibility of harvesting the CB as a vascularized bone transfer for DR reconstruction. Purposes We evaluated the feasibility of a vascularized bone transfer of the CB by performing the flap dissection, analyzing its pedicle and demonstrating its perfusion using indocyanine green (ICG) fluorescence angiography. Methods Ten feet from five fresh-frozen cadaver specimens were dissected. The lateral tarsal artery (LTA) mean diameter, length, and emerging point were described. The CB mean length and the mean length of the bone segment harvested were reported. ICG injection was used to demonstrate its blood supply. Results The average length of the pedicle was 68.26 ± 3.12 mm. The mean diameter was 1.43 ± 0.15 mm. The CB had a mean anterior–posterior length of 40.81 ± 5.05 mm. The harvested bone had a mean length of 15.05 ± 2.03 mm. All CBs showed enhancement after ICG injection. Conclusion The CB presented reasonable anatomical similarities with the DR and a long and consistent pedicle with an adequate blood supply observed during ICG injection. Clinical Relevance This study supports the possibility of using the CB as a vascularized bone transfer for autologous reconstruction of the articular surface of the DR. Further study is warranted.
背景足部立方体骨(CB)被认为是桡骨远端(DR)自体重建的潜在来源。本研究旨在探讨采集桡骨桡侧骨(CB)作为血管化骨转移用于桡骨远端重建的可行性。目的 我们通过剥离皮瓣、分析其蒂部并使用吲哚青绿(ICG)荧光血管造影显示其灌注情况,评估 CB 血管化骨转移的可行性。方法 从五具新鲜冷冻的尸体标本中解剖出十只脚。描述了外侧跗动脉(LTA)的平均直径、长度和起始点。报告了 CB 的平均长度和采集骨段的平均长度。采用 ICG 注入法显示其血液供应情况。结果 骨干的平均长度为 68.26 ± 3.12 毫米。平均直径为 1.43 ± 0.15 毫米。CB 的平均前后长度为 40.81 ± 5.05 毫米。取骨的平均长度为 15.05 ± 2.03 毫米。注射 ICG 后,所有 CB 均显示增强。结论 CB 在解剖学上与 DR 有合理的相似性,ICG 注射后可观察到长且一致的骨蒂和充足的血液供应。临床意义 本研究支持将 CB 作为血管化骨转移用于 DR 关节面自体重建的可能性。还需要进一步研究。
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引用次数: 0
Evaluation of Reliability of Dynamic Scapholunate Distance Measured on 4D CT-Acquired Images 评估在四维 CT 采集图像上测量的动态肩胛骨间距的可靠性
IF 0.7 Pub Date : 2024-04-16 DOI: 10.1055/s-0044-1786161
S. Goeminne, Emiel Salaets, Walter Coudyzer, Darshan Shah, Ilse Degreef, Lennart Scheys
Purpose A technique to measure scapholunate distance based on four-dimensional computed tomography (4D CT)-acquired images is presented. Methods Intra-observer variability was evaluated through a repeated-measures study. A 4D CT of seven patients suspected of scapholunate lesion was performed. Anatomical landmarks were identified on a three-dimensional reconstructed model of the wrist. All 4D CT datasets were evaluated thrice by two observers. Standard deviation of the differences between two measurements, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Results Intra-observer variability for the expert observer (ICC > 0.95) was lower than that of the novice observer (ICC > 0.77) and interobserver variability was low (ICC > 0.85). For the expert observer, measurement error (SEM < 0.13 mm and MDC < 0.36 mm) was smaller than that of the novice observer (SEM < 0.45 mm and MDC < 1.24 mm). Both SEM and MDC values were low, compared to the scan resolution and the absolute value of intervals. Conclusion The proposed assessment results in a reproducible and reliable measurement of scapholunate distance.
目的 介绍一种基于四维计算机断层扫描(4D CT)获得的图像测量肩胛骨距离的技术。方法 通过重复测量研究评估观察者内部的变异性。对七名疑似肩胛骨病变的患者进行了四维 CT 检查。在腕部的三维重建模型上确定了解剖地标。所有四维 CT 数据集均由两名观察者进行三次评估。计算两次测量之间差异的标准偏差、类间相关系数(ICC)、测量标准误差(SEM)和最小可检测变化(MDC)。结果 专家观察者的观察者内变异性(ICC > 0.95)低于新手观察者(ICC > 0.77),观察者间变异性较低(ICC > 0.85)。专家观察者的测量误差(SEM < 0.13 mm,MDC < 0.36 mm)小于新手观察者(SEM < 0.45 mm,MDC < 1.24 mm)。与扫描分辨率和间隔的绝对值相比,SEM 和 MDC 值均较低。结论 拟议的评估方法可对肩胛骨间距进行可重复和可靠的测量。
{"title":"Evaluation of Reliability of Dynamic Scapholunate Distance Measured on 4D CT-Acquired Images","authors":"S. Goeminne, Emiel Salaets, Walter Coudyzer, Darshan Shah, Ilse Degreef, Lennart Scheys","doi":"10.1055/s-0044-1786161","DOIUrl":"https://doi.org/10.1055/s-0044-1786161","url":null,"abstract":"\u0000 Purpose A technique to measure scapholunate distance based on four-dimensional computed tomography (4D CT)-acquired images is presented.\u0000 Methods Intra-observer variability was evaluated through a repeated-measures study. A 4D CT of seven patients suspected of scapholunate lesion was performed. Anatomical landmarks were identified on a three-dimensional reconstructed model of the wrist. All 4D CT datasets were evaluated thrice by two observers. Standard deviation of the differences between two measurements, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated.\u0000 Results Intra-observer variability for the expert observer (ICC > 0.95) was lower than that of the novice observer (ICC > 0.77) and interobserver variability was low (ICC > 0.85). For the expert observer, measurement error (SEM < 0.13 mm and MDC < 0.36 mm) was smaller than that of the novice observer (SEM < 0.45 mm and MDC < 1.24 mm). Both SEM and MDC values were low, compared to the scan resolution and the absolute value of intervals.\u0000 Conclusion The proposed assessment results in a reproducible and reliable measurement of scapholunate distance.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cuboid Bone for Distal Radius Reconstruction: An Anatomical Study by 3D Models 用于桡骨远端重建的立方体骨:三维模型解剖学研究
IF 0.7 Pub Date : 2024-04-15 DOI: 10.1055/s-0044-1785499
Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, A. Thione
Background Distal radius (DR) reconstruction due to high-energy trauma, degenerative processes, and oncologic resections can be a challenge when the articular surface is destroyed or resected. This study investigates the possibility of using the cuboid bone of the foot to replace the osteoarticular surface of DR. Purposes We compared the three-dimensional (3D) morphology of the articular surface of three foot bones with that of the DR to analyze which one would be the most suitable to replace it. Methods 3D bone models were created from a computed tomography (CT) scan database. The articular surfaces of calcaneus, cuboid bone, and lateral cuneiform bone were compared with that of the DR using the Hausdorff-Besicovitch morphometry analysis. Mean, maximum, and minimum differences were obtained and statistically analyzed. Results The cuboid bone had a mean overall area difference with the DR of 0.72 mm (standard deviation [SD], 0.03 mm). The lateral cuneiform bone showed 0.89 mm (SD, 0.08 mm). The calcaneus presented 1.04 mm (SD, 0.06 mm). The differences and the variability of the articular surface were statistically lower in the cuboid bone. Conclusion The articular surface of the cuboid bone has many similarities to the articular surface of the DR and had the most similarities to the DR of the foot bones study. The cuboid bone could be considered as a replacement for the DR in cases where there is a need for osteoarticular replacement or reconstruction. Further investigations are warranted. Clinical Relevance A vascularized transfer of the cuboid bone may be a suitable option to replace a DR given the anatomical similarities reported.
背景 因高能量创伤、退行性病变和肿瘤切除而导致的桡骨远端(DR)重建,在关节面被破坏或切除时可能是一项挑战。本研究探讨了使用足部立方体骨替代桡骨骨关节面的可能性。目的 我们比较了三种足骨的关节面与 DR 的关节面的三维(3D)形态,以分析哪一种最适合替代 DR。方法 根据计算机断层扫描(CT)数据库创建三维骨骼模型。使用 Hausdorff-Besicovitch 形态测量分析法将小方块骨、立方体骨和外侧楔骨的关节面与 DR 的关节面进行比较。得出了平均值、最大值和最小值差异,并进行了统计分析。结果 立方体骨与 DR 的平均总面积差异为 0.72 毫米(标准差 [SD],0.03 毫米)。外侧楔骨显示 0.89 毫米(标准差,0.08 毫米)。小腿骨为 1.04 毫米(标准差为 0.06 毫米)。据统计,立方体骨关节面的差异和变异性较低。结论 立方体骨的关节面与桡骨的关节面有许多相似之处,而且与足骨研究中的桡骨关节面最为相似。在需要进行骨关节置换或重建的情况下,可考虑用立方体骨替代 DR。还需要进一步研究。临床意义 鉴于所报告的解剖学相似性,长方体骨的血管化转移可能是替代DR的合适选择。
{"title":"Cuboid Bone for Distal Radius Reconstruction: An Anatomical Study by 3D Models","authors":"Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, A. Thione","doi":"10.1055/s-0044-1785499","DOIUrl":"https://doi.org/10.1055/s-0044-1785499","url":null,"abstract":"\u0000 Background Distal radius (DR) reconstruction due to high-energy trauma, degenerative processes, and oncologic resections can be a challenge when the articular surface is destroyed or resected. This study investigates the possibility of using the cuboid bone of the foot to replace the osteoarticular surface of DR.\u0000 Purposes We compared the three-dimensional (3D) morphology of the articular surface of three foot bones with that of the DR to analyze which one would be the most suitable to replace it.\u0000 Methods 3D bone models were created from a computed tomography (CT) scan database. The articular surfaces of calcaneus, cuboid bone, and lateral cuneiform bone were compared with that of the DR using the Hausdorff-Besicovitch morphometry analysis. Mean, maximum, and minimum differences were obtained and statistically analyzed.\u0000 Results The cuboid bone had a mean overall area difference with the DR of 0.72 mm (standard deviation [SD], 0.03 mm). The lateral cuneiform bone showed 0.89 mm (SD, 0.08 mm). The calcaneus presented 1.04 mm (SD, 0.06 mm). The differences and the variability of the articular surface were statistically lower in the cuboid bone.\u0000 Conclusion The articular surface of the cuboid bone has many similarities to the articular surface of the DR and had the most similarities to the DR of the foot bones study. The cuboid bone could be considered as a replacement for the DR in cases where there is a need for osteoarticular replacement or reconstruction. Further investigations are warranted.\u0000 Clinical Relevance A vascularized transfer of the cuboid bone may be a suitable option to replace a DR given the anatomical similarities reported.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complex Axial Carpal Dislocation with Scapholunate Ligament Injury 复杂轴性腕关节脱位伴肩胛韧带损伤
IF 0.7 Pub Date : 2024-04-15 DOI: 10.1055/s-0044-1785500
Sathya Vamsi Krishna, Nikunj Gondaliya
Background Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively. Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury. Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability. Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.
背景 轴性腕关节脱位(ACD)是一种高冲击性损伤,涉及腕骨近端和远端,增加了诊断和治疗的复杂性。本文探讨了一例独特的桡侧腕关节轴向脱位病例,强调了不可复位的第二腕掌关节(CMCJ)和同时存在的肩胛韧带(SL)损伤。了解轴性腕关节损伤的背景对于识别和有效处理这些复杂病例至关重要。描述 一名 27 岁的男子在一次摩托车事故中左腕受伤,显示出不可复位的第二 CMCJ 和独特的韧带损伤模式。尽管闭合复位尝试未果,手术干预包括背侧中线切口、第二CMCJ和SL间隙固定以及韧带修复。术后评估显示对位正确,SL间隙有轻微间隙,揭示了损伤的复杂性。文献综述 现有研究描述了一种从第三蹼间隙开始的轴向脱位,通过头臼-臼齿间隙导致肩胛骨脱位。然而,在本文中,我们描述了一种通过第二CMCJ导致SL间隙失稳的ACD变体。临床意义 识别并全面解决轴向桡侧腕关节脱位对患者的最佳治疗效果至关重要。该病例报告对涉及SL失稳的罕见ACD模式提供了宝贵的见解,这种模式在最初的X光片上被漏诊,但通过计算机断层扫描发现了,因此得到了适当的处理。任何 CMCJ 脱位都应引起对轴脱位的怀疑,除非事实证明并非如此。
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引用次数: 0
Radiocarpal Osteochondral Allografts for Wrist Pain Postproximal Row Carpectomy 桡骨骨软骨异体移植治疗近端行骨切除术后的腕痛
IF 0.7 Pub Date : 2024-04-11 DOI: 10.1055/s-0044-1781429
Kazimir Bagdady, Cedar Slovacek, Peter K. Firouzbakht, Brian A. Mailey
Background Surgical options for patients with recurrent wrist pain after salvage procedures, such as proximal row carpectomy (PRC), are limited and primarily result in total wrist arthrodesis (TWA). Osteochondral allografting (OCA) offers an additional option to address refractory wrist pain due to arthritis while preserving some range of motion. Case Description A 65-year-old, right hand dominant male developed chronic wrist pain, secondary to untreated scapholunate and triangular fibrocartilage complex ligament tears. The patient underwent a PRC, radial styloidectomy, and partial wrist denervation with good initial pain relief. Two years later, symptoms returned with radiographs demonstrating capitate sclerosis. A salvage arthroplasty with OCA produced relief of symptoms. Literature Review Refractory wrist pain after salvage procedures have traditionally been managed with TWA or less commonly, wrist arthroplasty. Capitate resurfacing and interposition have expanded indications for PRC. OCA is a chondral replacement procedure that utilizes cadaveric cartilage allograft plugs to replace damaged cartilage in various articular joint surfaces. Although OCA used in the lower extremity and shoulder has demonstrated improved pain relief and return of function, it has not been reported in the wrist. Clinical Relevance There are limited options for refractory wrist pain after salvage procedures. We present an additional alternative to TWA, by resurfacing the radiocarpal joint affected by chondromalacia after a PRC. This option offers another treatment modality for recurrent wrist pain while still preserving some element of range of motion.
背景 对经过近端行腕关节切除术(PRC)等挽救手术后复发腕关节疼痛的患者,手术选择有限,主要是全腕关节置换术(TWA)。骨软骨同种异体移植术(OCA)为解决关节炎引起的难治性腕痛提供了另一种选择,同时保留了一定的活动范围。病例描述 一位 65 岁的右手优势型男性因肩胛骨和三角纤维软骨复合韧带撕裂未得到治疗而引发慢性腕痛。患者接受了PRC、桡侧花键切除术和腕部部分神经支配术,最初疼痛得到了很好的缓解。两年后,症状再次出现,X光片显示头状硬化。使用 OCA 进行抢救性关节成形术后,症状得到缓解。文献综述 传统上,抢救性手术后的难治性腕痛可通过 TWA 或较少见的腕关节成形术来治疗。帽状腱膜复位和内固定术扩大了PRC的适应症。OCA是一种软骨置换术,利用尸体软骨异体移植栓来置换各种关节面的受损软骨。虽然在下肢和肩部使用 OCA 能有效缓解疼痛并恢复功能,但在腕部使用这种方法的报道还不多。临床意义 对于抢救性手术后的难治性腕痛,可供选择的治疗方案有限。我们提出了除 TWA 之外的另一种选择,即在 PRC 术后对受软骨软化症影响的桡腕关节进行再植。这种方法为复发性腕痛提供了另一种治疗方式,同时还保留了一定的活动范围。
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引用次数: 0
Dorsal Intercarpal Ligament Tears: An Arthroscopic Classification and Clinical Outcomes Study 背侧腕间韧带撕裂:关节镜分类和临床结果研究
IF 0.7 Pub Date : 2024-03-30 DOI: 10.1055/s-0044-1785505
L. Merlini, Sze Ryn Chung, M. Caloia
Background The dorsal intercarpal (DIC) ligament plays a significant role in carpal stability and is often associated with other carpal ligament injuries. Isolated DIC ligament injuries are rare and can present as a ligament avulsion, bony avulsion, or attenuation due to chronic injury. Previously, we described the first isolated DIC ligament avulsion and proposed an arthroscopic repair technique. This article presents an arthroscopic classification of DIC ligament complex injuries and outcomes in a larger series of patients. Methods A retrospective review was conducted on 16 patients who had undergone arthroscopic repair of the DIC ligament from 2018 to 2022. Intraoperative arthroscopic findings were documented, leading to the proposal of a classification system for DIC ligament tears. Pre- and postoperative outcomes, including the range of motion, grip strength, visual analog scale (VAS) pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) outcomes, were assessed in this cohort. Results At a mean follow-up of 17.8 months, there was a statistically significant improvement in wrist flexion (65.3 to 74.3 degrees), wrist extension (77.8 to 84.5 degrees), comparative grip strength (46.4 to 87% compared with contralateral wrist), VAS score (6.3 to 0.6), and QuickDASH score (54.8 to 4.5). Four out of 16 patients (25%) had isolated DIC ligament tears, and the remaining 12 (75%) had concomitant intercarpal ligament injuries. Conclusion The study highlights the critical role of the DIC ligament in carpal stability and introduces an arthroscopic classification for evaluating this lesion. Surgical options for different types of DIC ligament tears were also discussed. Level of Evidence Level III, Retrospective study.
背景 腕背间(DIC)韧带在腕关节稳定性方面起着重要作用,并且经常与其他腕韧带损伤相关联。孤立的 DIC 韧带损伤非常罕见,可表现为韧带撕脱、骨性撕脱或慢性损伤导致的衰减。在此之前,我们描述了第一例孤立的DIC韧带撕脱,并提出了一种关节镜修复技术。本文介绍了 DIC 韧带复合体损伤的关节镜分类以及更多患者的治疗效果。方法 对2018年至2022年期间接受关节镜修复DIC韧带的16例患者进行回顾性回顾。记录了术中关节镜检查结果,并据此提出了 DIC 韧带撕裂的分类系统。对该队列的术前和术后结果进行了评估,包括活动范围、握力、视觉模拟量表(VAS)疼痛评分以及手臂、肩部和手部快速残疾问卷(QuickDASH)结果。结果 在平均 17.8 个月的随访中,腕关节屈曲度(65.3 度到 74.3 度)、腕关节伸展度(77.8 度到 84.5 度)、比较握力(与对侧腕关节相比,46.4% 到 87%)、VAS 评分(6.3 分到 0.6 分)和 QuickDASH 评分(54.8 分到 4.5 分)均有显著改善。16 名患者中有 4 人(25%)为孤立的 DIC 韧带撕裂,其余 12 人(75%)同时伴有腕间韧带损伤。结论 该研究强调了 DIC 韧带在腕关节稳定性中的关键作用,并介绍了评估该病变的关节镜分类方法。研究还讨论了不同类型 DIC 韧带撕裂的手术方案。证据等级 III 级,回顾性研究。
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Journal of Wrist Surgery
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