两角、三角和四角关节成形术治疗中腕关节炎的比较研究

IF 1.8 Q2 ORTHOPEDICS
HAND Pub Date : 2024-11-01 Epub Date: 2023-06-02 DOI:10.1177/15589447231174046
Justine Ring, Tod A Clark, Jennifer L Giuffre
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引用次数: 0

摘要

背景:四角融合术(4CF)是治疗中腕关节炎的常用方法,但也有包括二角融合术(2CF)和三角融合术(3CF)在内的替代方法。有限的文献表明,2CF 和 3CF 可改善活动范围,但并发症发生率较高。我们的目的是比较本院接受 4CF、3CF 和 2CF 术后的功能和患者报告的结果:方法:纳入2011年至2021年期间接受4CF、3CF和2CF手术且至少参加过一次随访的成年患者。将四角融合术患者与使用订书钉固定的 3CF 或 2CF 患者进行比较。结果包括不愈合率、再手术率、腕部融合进展、活动范围、患者报告的疼痛、满意度以及手臂、肩部和手部残疾(DASH)评分:共有 58 名患者符合纳入标准。结果:共有58名患者符合纳入标准,其中4CF患者49名,2CF或3CF患者9名。各组间的非愈合率、进展为腕关节融合术以及因任何指征而再次手术的情况无明显差异。术后访视时的活动范围(屈伸、桡尺偏移)和握力无明显差异。需要植骨的 4CF 患者明显较多。疼痛、总体满意度和DASH评分相似:尽管之前的研究表明 2CF/3CF 术后发生骨不连和硬件移位的风险会增加,但与 4CF 相比,我们并未观察到更高的并发症发生率。活动范围、力量和患者报告的结果相似。虽然 4CF 是传统的中腕骨融合术的首选,但我们发现,在使用钉书针固定技术时,2CF 和 3CF 的临床和患者报告结果相当,而且减少了对自体骨移植的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Comparative Study of 2-Corner, 3-Corner, and 4-Corner Arthrodesis for Midcarpal Arthritis.

Background: Four-corner fusion (4CF) is a common treatment for midcarpal arthritis; however, alternatives including 2-corner fusion (2CF) and 3-corner fusion (3CF) have been described. Limited literature suggests 2CF and 3CF may improve range of motion but have higher complication rates. Our objective is to compare function and patient-reported outcomes following 4CF, 3CF, and 2CF at our institution.

Methods: Adult patients undergoing 4CF, 3CF, and 2CF from 2011 to 2021 who attended at least one follow-up were included. Four-corner fusion patients were compared with those who underwent either 3CF or 2CF using staple fixation. Outcomes include nonunion rate, reoperation rate, progression to wrist fusion, range of motion, and patient-reported pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.

Results: A total of 58 patients met inclusion criteria. There were 49 4CF and 9 2CF or 3CF patients. Nonunion rates, progression to wrist fusion, and repeat surgery for any indication were not significantly different among groups. Range of motion (flexion-extension, radial-ulnar deviation) and grip strength at postoperative visits were not significantly different. Significantly more 4CF patients required bone grafting. Pain, overall satisfaction, and DASH scores were similar.

Conclusions: Although prior studies suggest increased risk of nonunion and hardware migration after 2CF/3CF, we did not observe higher complication rates compared with 4CF. Range of motion, strength, and patient-reported outcomes were similar. While 4CF is traditionally the procedure of choice for midcarpal fusion, we found that when using a staple fixation technique, 2CF and 3CF have comparable clinical and patient-reported outcomes yet decrease the need for autologous bone grafting.

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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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