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Abstract：
Background Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student\'s t -test with 145 degrees of freedom and α = 0.05. Results We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from -7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence Level IV, cohort study. Clinical Relevance Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.
摘要：
背景技术对于慢性肩胛骨（SL）损伤的管理仍在进行许多辩论。我们提出了一种关节镜下的背侧囊式固定术，具有良好的临床效果。我们现在提出放射学随访。目的：为了确定关节镜下背侧囊式固定术是否可以改善X线摄影SL角度，并随着时间的推移保持这种校正。方法从2020年1月至2021年1月，我们纳入每位患有SL不稳定的患者，并根据欧洲腕关节镜学会（EWAS）分类对其进行分类。所有患者均进行了双侧X射线检查，并测量了病理和健康侧的放射液（RL）和SL角度。我们还纳入了患有肺纤维软骨或三角形纤维软骨复合体病变的患者。排除标准是关节炎的存在以及囊式固定术后持续的术中SL不稳定。如Mathoulin最初描述的那样，对所有患者进行了关节镜背侧囊式固定术。然后在术后即刻的X射线上再次测量RL和SL角度，然后在术后3、6和12个月再次。使用具有145个自由度和α=0.05的配对Student'st检验进行统计分析。结果共纳入146例患者，随访1年。RL角和SL角均在术后12个月接近健康侧。RL角从-7.23度增加到4.37度；差异仍有统计学意义，但它几乎等于健康的一面（5.16度）。SL角度已从74.55降至54.95；差异仍具有统计学和放射学意义（6.788度），但已降低了74.3％。结论这项研究表明，该技术可以随着时间的推移使背侧插层节段不稳定（DISI）正常化，而无需进行任何固定或侵入性韧带重建手术。证据级别IV级,队列研究。临床相关性在所有可减轻的SL损伤中均应考虑背侧囊式固定术。即使DISI存在。
