Abstract：
BACKGROUND: The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation.
METHODS: This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured.
RESULTS: The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively).
CONCLUSIONS: This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.
METHODS: This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured.
RESULTS: The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively).
CONCLUSIONS: This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.
摘要：
背景：肩胛骨韧带是肩胛骨关节最重要的稳定器。在没有预先存在的腕关节关节炎的情况下，这种韧带的慢性不可逆损伤的处理仍存在争议。最近,外科医生介绍了一种使用内部支架（IB）的新型手术技术。已经使用尸体对该技术进行了一些生物力学研究；但是，很少有研究在实际临床实践中详细讨论了结果。因此,在这里，我们调查了接受IB增强治疗慢性肩胛骨游离的患者的放射学和功能结果.
方法：这项回顾性研究于2018年4月至2022年5月进行。使用IB增强技术治疗了22例慢性肩胛骨游离的患者，其中17人随访至少1年。放射学结果,包括肩胛骨距离,肩胛骨角,和辐射计角度，被收集。此外，临床参数,如视觉模拟量表（术前和最终随访时），手臂的残疾，肩膀,和手部评分（术前和术后3、6和12个月），和Mayo腕部评分（术前和最终随访时），被测量。
结果：与未受影响的手腕相比，受影响的手腕中的肩胛骨距离显着增加，在所有腕部位置重建后改善(P<0.05)。与未受影响的手腕相比，除伸张外（P=0.535），所有位置的肩胛骨角都显着增加（P<0.05），并且在所有腕部位置重建后都有所改善。除伸展（P=0.602）和握紧拳头（P=0.556）外，所有位置的放射性舟骨角度均显着增加（P<0.05）。除了伸展外，在所有手腕位置重建后，该角度都得到了改善（P=0.900）。术后视觉模拟量表评分（7-2，术前和最终随访）和Mayo腕部评分（53-82，术前和最终随访）改善。手臂的残疾，肩膀,手术后Hand评分也有所改善(68,53,30,7,术前和术后3,6和12个月).
结论：这项研究表明，使用自体肌腱和缝合带重建肩胛骨韧带是一种良好的重建技术，可以改善临床症状和影像学参数，与其他重建方法相比，手术时间短，并发症少。
方法：这项回顾性研究于2018年4月至2022年5月进行。使用IB增强技术治疗了22例慢性肩胛骨游离的患者，其中17人随访至少1年。放射学结果,包括肩胛骨距离,肩胛骨角,和辐射计角度，被收集。此外，临床参数,如视觉模拟量表（术前和最终随访时），手臂的残疾，肩膀,和手部评分（术前和术后3、6和12个月），和Mayo腕部评分（术前和最终随访时），被测量。
结果：与未受影响的手腕相比，受影响的手腕中的肩胛骨距离显着增加，在所有腕部位置重建后改善(P<0.05)。与未受影响的手腕相比，除伸张外（P=0.535），所有位置的肩胛骨角都显着增加（P<0.05），并且在所有腕部位置重建后都有所改善。除伸展（P=0.602）和握紧拳头（P=0.556）外，所有位置的放射性舟骨角度均显着增加（P<0.05）。除了伸展外，在所有手腕位置重建后，该角度都得到了改善（P=0.900）。术后视觉模拟量表评分（7-2，术前和最终随访）和Mayo腕部评分（53-82，术前和最终随访）改善。手臂的残疾，肩膀,手术后Hand评分也有所改善(68,53,30,7,术前和术后3,6和12个月).
结论：这项研究表明，使用自体肌腱和缝合带重建肩胛骨韧带是一种良好的重建技术，可以改善临床症状和影像学参数，与其他重建方法相比，手术时间短，并发症少。
