Carpal Joints

腕关节
  • 文章类型: English Abstract
    UNASSIGNED: To summarize the research progress of scaphotrapeziotrapezoid osteoarthritis (STT OA) and its etiology and clinical treatment.
    UNASSIGNED: The domestic and foreign literature on STT OA in recent years was reviewed and the research progress was summarized.
    UNASSIGNED: STT OA is a common OA, which is highly prevalent in postmenopausal women and diagnosed by wrist X-ray films. The current treatment methods include conservative treatment and surgery. Among them, the conservative treatment can relieve clinical symptoms, but the long-term effectiveness is not ideal. In surgical treatment, scaphoid arthrodesis can effectively relieve wrist pain, but it sacrifices part of the range of motion and grip strength of the wrist, and there is a risk of fusion failure. Distal scaphoid resection and trapezium resection have the advantages of short operation time, simple operation, less damage to the joint capsule and ligament, and shorter postoperative external fixation time, but they lead to changes in carpal bone alignment and dorsal intercalated segmental instability. Arthroplasty can provide pain relief while restoring grip strength and preserving wrist motion, but there is a risk of dislocation of the prosthesis.
    UNASSIGNED: At present, there is no gold standard for the STT OA treatment. The short-term effectiveness of arthroplasty and arthroscopic distal scaphoid resection are satisfactory, but the long-term effectiveness needs further study.
    UNASSIGNED: 总结舟大小关节炎(scaphotrapeziotrapezoid osteoarthritis,STT OA)病因及临床诊疗方法研究进展。.
    UNASSIGNED: 查阅国内外近年有关STT OA的相关文献,总结研究进展。.
    UNASSIGNED: STT OA是一种常见骨关节炎,绝经后女性是高发人群,通常经腕部 X 线片检查即可诊断。目前治疗方式包括保守治疗及手术两类。其中,保守治疗能缓解临床症状,但远期疗效不理想。手术治疗中,关节融合术能较好地缓解患者腕部疼痛,但牺牲了腕关节部分活动度和握力,且有融合失败的风险;舟骨远端切除术和大多角骨切除术具有手术时间短、手术操作简便、对关节囊和韧带损伤小、术后固定时间较短等优点,但容易导致腕骨排列改变及腕背侧镶嵌不稳定;关节置换术能在恢复握力与保留腕关节活动度的基础上缓解疼痛,但有假体脱位风险。.
    UNASSIGNED: 目前STT OA治疗方式尚无金标准,关节假体置换术和关节镜下舟骨远端切除术早期疗效满意,但是远期疗效还需进一步研究。.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    OBJECTIVE: To observe the clinical effects of zheng\'s massage combined with electroacupuncture in the treatment ofreflex sensory dystrophy syndrome of the wrist.
    METHODS: From October 2016 to September 2018, 48 cases of reflex sensory dystrophy syndrome of the wrist were divided into the observation group and the control group. In the observation group, there were 24 cases, including 10 males and 14 females, ranging in age from 54 to 76 years old, with an average age of (61.41 ±7.90) years old. The patients in the observation group were treated with Zheng\'s massage combined with electroacupuncture. The control group consisted of 24 patients, including 9 males and 15 females, ranging in age from 52 to 75 years old, with an averageage of (58.71±8.11 ) years old. The patients in the control group were treated with electroacupuncture alone. All the patients in both groups were treated for 6 weeks. The clinical symptoms and signs, visual anglogue scale (VAS), Cooney wrist score and clinical efficacy evaluation were compared between the two groups before and after treatment, and statistical analysis was conducted.
    RESULTS: After 6 weeks of treatment, VAS in the control group was 4.9±1.8, and Cooney wrist score was 74.63±1.72; VAS in the observation group was 2.2±1.4, and Cooney wrist score was 86.31±2.53. The comprehensive scores of VAS and Cooney wrist joint between two groups were improved after treatment, and the observation group was better than control group(P<0.05). The curative effect of the observation group was better than that of the control group.
    CONCLUSIONS: Zheng\'s massage combined with electroacupuncture has the following advantages in the treatment of reflex sympathetic dystrophy syndrome of the wrist, such as small trauma, patients\' willingness promoting functional rehabilitation, which is worthy of clinical promotion.
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  • 文章类型: Journal Article
    OBJECTIVE: To evaluate the effect of open reduction assisted by wrist arthroscopy in the treatment of Diepunch fracture of the distal radius.
    METHODS: The clinical data of 50 patients with die punch fracture of distal radius from December 2015 to May 2017 were analyzed retrospectively, including 31 males and 19 females, aged 20 to 45 (34.12±2.56) years. All patients were treated with open reduction and internal fixation of volar plate through volar approach under the assistance of wrist arthroscope. The range of wrist movement and Cooney wrist function score before and after treatment were compared.
    RESULTS: All patients were followed up with an average of 18 months. DR scan showed that all fractures healed and no shortening of radial axis. Three cases of incision infection occurred and disappeared after treatment. At 18 months after operation, the range of wrist movement was significantly larger than that before operation (P<0.05) . At 18 months after operation, Cooney wrist function score was higher than that before operation (P<0.05) , excellent in 33 cases, good in 13 cases, fair in 3 cases and poor in 1 case.
    CONCLUSIONS: The treatment of die punch fracture of the distal radius with open reduction assisted by arthroscopy can restore the flatness of the joint surface, promote the recovery of the function of the wrist joint quickly, and has high safety, which is worth popularizing.
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  • 文章类型: Journal Article
    OBJECTIVE: To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy.
    METHODS: From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed.
    RESULTS: All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair.
    CONCLUSIONS: The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.
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  • 文章类型: Journal Article
    To realize the automated bone age assessment by applying deep learning to digital radiography (DR) image recognition of left wrist joint in Uyghur teenagers, and explore its practical application value in forensic medicine bone age assessment.
    The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60% of male and female DR images of left wrist joint were selected as net train set, and 10% of samples were selected as validation set. As test set, the rest 30% were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age.
    The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively.
    The combination of bone age research on teenagers\' left wrist joint and deep learning, which has high accuracy and good feasibility, can be the research basis of bone age automatic assessment system for the rest joints of body.
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  • 文章类型: Journal Article
    To investigate the changes in length of the scapholunate interosseous ligament (SLIL) when the wrist is resisting horizontal lateral load and the forearm is in full pronation in vivo.
    We obtained computed tomography scans of the wrists of 6 volunteers in 3 situations: 0° position (0° extension and 0° ulnar inclination) and full forearm pronation without force, and in the same position but with resisted ulnar and radial deviation. Nine zones of 3 subregions of the SLIL were measured and analyzed with computer modeling.
    Changes in length of the palmar SLIL with resisted ulnar deviation were significantly greater than those without an applied lateral load. In contrast, the changes in length of the dorsal SLIL with resisted radial deviation were statistically greater than those in the 0° position without loading. However, no significant differences in the changes in length of the proximal SLIL were found in any of 3 situations, except the dorsal zone with resisted radial deviation.
    Application of lateral load has an effect on the separation of the palmar and dorsal insertions of the SLIL. The palmar subregion of the SLIL was more highly strained with wrist-resisted ulnar deviation. Conversely, the dorsal subregion of the SLIL was under greater tension with wrist-resisted radial deviation.
    For patients undergoing nonsurgical treatment of SLIL tears, a sudden contraction of ulnar or radial deviation agonist muscles may be harmful and contribute to SL instability.
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  • 文章类型: Journal Article
    The key to successful treatment of perilunate injuries is to achieve early anatomic reduction and maintain the carpal alignment. Open surgery may lead to capsular scarring and joint stiffness. Furthermore, there is increased chance of damage of the already tenuous blood supply to scaphoid and the torn ligaments. Recently, arthroscopic-assisted management of perilunate injuries has been suggested. This article describes the surgical technique and outcome of this minimally invasive approach for perilunate injuries.
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  • 文章类型: Comparative Study
    OBJECTIVE: The scapholunate interossous ligament (SLIL) has a critical role in maintaining the proper kinematic relationship between the scaphoid and the lunate. We hypothesize that the length of SLIL changes significantly at wrist full extension and during forearm rotation. The aim of this study was to investigate the length changes of SLIL at wrist full extension and forearm rotation in vivo.
    METHODS: Twelve volunteers were randomly divided to two groups. We obtained computed tomography scans of the wrists at different wrist positions. The three regions of the SLIL were measured and analyzed with computer modeling.
    RESULTS: The results showed that from the neutral to full extension of the wrist, the length of volar SLIL and volar, middle portions of the proximal SLIL increased significantly. The volar and proximal SLIL increased significantly in maximal forearm pronation.
    CONCLUSIONS: The lengths of the volar and proximal regions of SLIL increase substantially at wrist full extension, but only slightly at maximal forearm pronation. Clinically, wrist full extension may make the SLIL ligament vulnerable to disruption.
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  • 文章类型: Evaluation Study
    The aim of this study was to evaluate the clinical outcomes of the memory plates for four-corner fusion (FCF) of scaphoid non-union advanced collapse (SNAC). From 2005-2010, 11 cases of SNAC received FCF with the memory plate designed by the authors. At an average follow-up of 21 months, there were no non-unions and postoperative infections. One patient complained of dorsal impingement. The pain relief rate was 100% and the average grip strength increased from 11.3% preoperatively to 56.3% postoperatively of the contralateral side. The primary results of FCF with memory plates are promising. By its compressive property, the memory plate facilitates the arthrodesis with a lower complication rate.
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