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Abstract：
Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears. Methods A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears. All patients failed a trial of conservative management consisting of scapholunate strengthening exercises. Patients underwent an arthroscopic dorsal capsular tightening of the radiocarpal joint capsule radial to the origin of the dorsal radiocarpal ligament and proximal to the dorsal intercarpal ligament by either thermal shrinkage or dorsal capsule abrasion. Demographic data, radiological outcomes, patient-rated outcome measures and objective measures of wrist range of motion (ROM), and grip and pinch strength were recorded. Postoperative outcome scores were collected at 3, 6, 12, and 24 months. Data are reported as median and interquartile range, and comparisons were drawn between baseline and last follow-up. Clinical outcome data were analyzed using a linear mixed model method, while radiographic outcomes were assessed with nonparametric analysis with p < 0.05 indicating statistical significance. Results Twenty-three wrists (22 patients) underwent SLL treatment by thermal capsular shrinkage (19 wrists) or dorsal capsular abrasion (4 wrists). Median age at surgery was 41 years (range: 32-48) and median follow-up time was 12 months (range: 3-24). Pain significantly decreased from 62 (45-76) to 18 (7-41) and satisfaction significantly increased from 2 (0-24) to 86 (52-92). Patient-Rated Wrist and Hand Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand significantly improved from 68 (38-78) to 34 (13-49) and from 48 (27-55) to 36 (4-58), respectively. Median grip and tip pinch strength significantly increased at final review. Range of movement and lateral pinch strength were satisfactory and maintained. Four patients required further surgery for ongoing pain or reinjury. All were successfully managed with partial wrist fusion or wrist denervation. Conclusion Arthroscopic ligament-sparing dorsal capsular tightening is a safe and effective treatment for partial SLL tears. Dorsal capsular tightening demonstrates good pain relief and patient satisfaction while improving patient-reported outcomes, grip strength, and maintaining ROM. Longer term studies are required to determine the longevity of these results.
摘要：
介绍各种腕关节镜检查技术可用于治疗肩胛骨韧带（SLL）部分撕裂，但尚未证明其成功。包括热收缩在内的关节镜技术在部分SLL损伤的治疗中变得越来越流行。我们假设关节镜下保留韧带的囊收紧可为部分SLL撕裂的治疗提供可靠且令人满意的结果。方法对成人(年龄≥18岁)慢性部分性SLL泪液患者进行前瞻性队列研究。所有患者均未通过保守治疗的试验，该治疗包括肩胛骨加强运动。通过热收缩或背侧囊磨损，患者接受了关节镜下对radial腕关节囊的背侧囊收紧，以放射状至背侧腕韧带的起源和腕间韧带的近端。人口统计数据,放射学结果，患者评估的结果测量和手腕活动范围（ROM）的客观测量，并记录握力和捏合强度。收集术后3、6、12和24个月的结果评分。数据报告为中位数和四分位数范围，并在基线和最后一次随访之间进行比较。使用线性混合模型方法分析临床结果数据，而影像学结局采用非参数分析评估，p<0.05表明有统计学意义。结果23例（22例）通过热囊收缩（19例）或背侧囊磨损（4例）进行SLL治疗。手术的中位年龄为41岁（范围：32-48），中位随访时间为12个月（范围：3-24）。疼痛从62（45-76）降至18（7-41），满意度从2（0-24）降至86（52-92）。患者额定腕部和手部评估和手臂的快速残疾，肩膀,和手从68（38-78）到34（13-49），从48（27-55）到36（4-58），分别。在最终审查时，中间握力和尖端夹紧强度显着增加。运动范围和横向夹紧强度令人满意并保持不变。四名患者因持续疼痛或再受伤而需要进一步手术。所有患者均通过部分腕部融合或腕部神经支配成功。结论关节镜下保留韧带的背侧囊收紧术是治疗SLL部分性撕裂的一种安全有效的方法。背囊收紧显示良好的疼痛缓解和患者满意度，同时改善患者报告的结果，握力,维护ROM。需要更长期的研究来确定这些结果的寿命。
