Abstract：
OBJECTIVE: Anatomical front and back (ANAFAB) reconstruction addresses the critical volar and dorsal ligaments associated with scapholunate dissociation. We hypothesized that patients with symptomatic, chronic, late-stage scapholunate dissociation would demonstrate improvements in all radiographic parameters and patient-reported outcomes (PROMs) after ANAFAB reconstruction.
METHODS: From 2018 to 2021, 21 ANAFAB reconstructions performed by a single surgeon were followed prospectively, with 20 patients having a minimum follow-up of 12 months. In total, 17 men and four women were included, with an average age of 49 years. Three patients had modified Garcia-Elias stage 3 disease, eight stage 4, seven stage 5, and three stage 7. ANAFAB reconstruction of intrinsic and extrinsic ligament stabilizers was performed using a hybrid synthetic tape/tendon graft in a transosseous reconstruction. Pre- and postoperative radiographic parameters, grip, pinch strength, the Patient-Rated Wrist Evaluation, PROMIS Upper Extremity Function, and PROMIS Pain Interference outcome measures were compared.
RESULTS: Mean follow-up was 17.9 months (range: 12-38). Radiographic parameters were improved at follow-up, including the following: scapholunate angle (mean 75.3° preoperatively to 69.2°), scapholunate gap (5.9-4.2 mm), dorsal scaphoid translation (1.2-0.2 mm), and radiolunate angle (13.5° to 1.8°). Mean Patient-Rated Wrist Evaluation scores for pain and function decreased from 40.6 before surgery to 10.4. We were unable to detect a significant difference in grip or pinch strength or radioscaphoid angle with the numbers tested. There were two minor complications, and two complications required re-operations, one patient who was converted to a proximal row carpectomy for failure of fixation, and one who required tenolysis/arthrolysis for arthrofibrosis.
CONCLUSIONS: At 17.9-month average follow-up, radiographic and patient-reported outcome parameters improved after reconstruction of the critical dorsal and volar ligament stabilizers of the proximal carpal row with the ANAFAB technique.
METHODS: Therapeutic IV.
METHODS: From 2018 to 2021, 21 ANAFAB reconstructions performed by a single surgeon were followed prospectively, with 20 patients having a minimum follow-up of 12 months. In total, 17 men and four women were included, with an average age of 49 years. Three patients had modified Garcia-Elias stage 3 disease, eight stage 4, seven stage 5, and three stage 7. ANAFAB reconstruction of intrinsic and extrinsic ligament stabilizers was performed using a hybrid synthetic tape/tendon graft in a transosseous reconstruction. Pre- and postoperative radiographic parameters, grip, pinch strength, the Patient-Rated Wrist Evaluation, PROMIS Upper Extremity Function, and PROMIS Pain Interference outcome measures were compared.
RESULTS: Mean follow-up was 17.9 months (range: 12-38). Radiographic parameters were improved at follow-up, including the following: scapholunate angle (mean 75.3° preoperatively to 69.2°), scapholunate gap (5.9-4.2 mm), dorsal scaphoid translation (1.2-0.2 mm), and radiolunate angle (13.5° to 1.8°). Mean Patient-Rated Wrist Evaluation scores for pain and function decreased from 40.6 before surgery to 10.4. We were unable to detect a significant difference in grip or pinch strength or radioscaphoid angle with the numbers tested. There were two minor complications, and two complications required re-operations, one patient who was converted to a proximal row carpectomy for failure of fixation, and one who required tenolysis/arthrolysis for arthrofibrosis.
CONCLUSIONS: At 17.9-month average follow-up, radiographic and patient-reported outcome parameters improved after reconstruction of the critical dorsal and volar ligament stabilizers of the proximal carpal row with the ANAFAB technique.
METHODS: Therapeutic IV.
摘要：
目的：解剖前后（ANAFAB）重建解决了与肩胛骨分离相关的关键掌侧和背侧韧带。我们假设有症状的患者，慢性，晚期肩胛骨解离将显示ANAFAB重建后所有影像学参数和患者报告结局(PROMs)的改善.
方法：从2018年到2021年，前瞻性地跟踪了21名由一名外科医生进行的ANAFAB重建，20例患者的最低随访时间为12个月。总的来说,包括17名男性和4名女性，平均年龄49岁。三名患者患有改良的Garcia-Elias3期疾病，八个阶段4，七个阶段5和三个阶段7。在跨骨重建中，使用混合合成胶带/肌腱移植物进行了内在和外在韧带稳定剂的ANAFAB重建。术前和术后影像学参数，握把,夹紧强度,患者额定腕部评估,PROMIS上肢功能，和PROMIS疼痛干扰结果测量进行了比较。
结果：平均随访时间为17.9个月（范围：12-38）。射线照相参数在随访中得到改善，包括：肩胛骨角度（术前平均75.3°至69.2°），肩胛骨间隙（5.9-4.2mm），背侧舟骨平移（1.2-0.2mm），和放射状角度（13.5°至1.8°）。平均患者评分的腕关节疼痛和功能评分从手术前的40.6降至10.4。通过测试的数字，我们无法检测到抓地力或捏合强度或放射性核素角度的显着差异。有两个小并发症,两个并发症需要再次手术，一名患者因固定失败而转换为近端行腕管切除术，和一个需要肌腱松解术/关节松解术治疗关节纤维化的人。
结论：平均随访17.9个月时，使用ANAFAB技术重建腕骨近端的关键背侧和掌侧韧带稳定器后，影像学和患者报告的结局参数得到改善。
方法：治疗IV。
方法：从2018年到2021年，前瞻性地跟踪了21名由一名外科医生进行的ANAFAB重建，20例患者的最低随访时间为12个月。总的来说,包括17名男性和4名女性，平均年龄49岁。三名患者患有改良的Garcia-Elias3期疾病，八个阶段4，七个阶段5和三个阶段7。在跨骨重建中，使用混合合成胶带/肌腱移植物进行了内在和外在韧带稳定剂的ANAFAB重建。术前和术后影像学参数，握把,夹紧强度,患者额定腕部评估,PROMIS上肢功能，和PROMIS疼痛干扰结果测量进行了比较。
结果：平均随访时间为17.9个月（范围：12-38）。射线照相参数在随访中得到改善，包括：肩胛骨角度（术前平均75.3°至69.2°），肩胛骨间隙（5.9-4.2mm），背侧舟骨平移（1.2-0.2mm），和放射状角度（13.5°至1.8°）。平均患者评分的腕关节疼痛和功能评分从手术前的40.6降至10.4。通过测试的数字，我们无法检测到抓地力或捏合强度或放射性核素角度的显着差异。有两个小并发症,两个并发症需要再次手术，一名患者因固定失败而转换为近端行腕管切除术，和一个需要肌腱松解术/关节松解术治疗关节纤维化的人。
结论：平均随访17.9个月时，使用ANAFAB技术重建腕骨近端的关键背侧和掌侧韧带稳定器后，影像学和患者报告的结局参数得到改善。
方法：治疗IV。
