PDF(Pubmed)
Abstract：
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
摘要：
背景在前动力或动力肩胛骨(SL)不稳定中，标准诊断成像可能无法识别SL骨间韧带(SLIL)损伤，导致延迟检测和干预。这项研究描述了使用四维计算机断层扫描（4DCT）来识别早期SLIL损伤以及术后1年的手腕受伤。技术描述4DCT获取具有高时间分辨率(66ms)的一系列三维体数据。4DCT衍生的关节运动学数据可以用作韧带完整性的生物标志物。患者和方法本研究介绍了在两个参与者的病例系列中使用4DCT来评估术前和术后1年单侧SLIL损伤后关节运动学的变化。患者接受掌侧韧带固定术和关节镜下背侧囊式固定术的掌侧韧带修复。比较未受伤的关节运动学，术前受伤，和术后受伤（修复）的手腕。结果4DCT检测到屈伸和尺尺偏时骨间距离的变化。一般来说,在屈伸和桡尺偏时，未受伤的腕关节中radi骨关节距离最大，在屈伸和下尺偏时，未受伤的手腕中SL间隔距离最小。结论4DCT在运动过程中提供了对腕关节运动学的见解。可以将辐射骨关节和SL间隔之间的距离显示为接近图或简化的描述性统计量，以促进手腕和时间点之间的比较。这些数据提供了有关骨间距离减少和腕间舒张增加的关注领域的见解。这种方法可以让外科医生评估是否（1）损伤可以在运动过程中可视化，(2)手术修复损伤,（3）手术恢复了正常的腕关节运动。证据级别IV级,案例系列。
