双中心锁定髓内钉治疗腕关节融合术

Pub Date : 2023-10-16 DOI:10.1055/s-0043-1776114
John J. Heifner, Robert J. Rowland, Osmanny Gomez, Francisco Rubio, George S. Kardashian
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引用次数: 0

摘要

总的来说,髓内锁定(IM)钉治疗全腕融合(TWF)的疗效各不相同,这表明需要进一步的研究。目前尚不清楚第三腕掌关节(CMCJ)的准备是否会降低并发症的风险,包括远端螺钉松动。我们的目的是(a)报告使用锁定内钉进行腕关节融合术的临床结果,(b)确定维持原生第三CMCJ关节是否会导致短期并发症。患者和方法回顾了2010年至2022年在两家机构使用IMPLATE锁定钉固定TWF的病例(骨骼动力学,迈阿密,佛罗里达州)。收集临床和影像学结果。结果影像学愈合率93.8%,其中延迟愈合1例。患者腕部评估评分平均为30.4分,静息疼痛视觉模拟评分平均为1.7分,日常生活活动视觉模拟评分平均为3.2分。有7例远端螺钉松动(21.8%),3例翻修手术(9.4%),其中包括两次种植体移除。桡骨长钉24例(75%),掌骨短钉3例(9%)。结论目前的系列具有令人满意的功能,在未将第三CMCJ纳入融合块的情况下,IM钉TWF后的翻修手术率低。远端螺钉松动的病例有不同的临床表现,我们目前的做法是为达到干预阈值的病例提供门诊螺钉拆卸。证据水平IV回顾性系列。
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A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion
Abstract Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.
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