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首页> 外文期刊>Journal of Hand Surgery. American Volume >4-corner arthrodesis and proximal row carpectomy: A biomechanical comparison of wrist motion and tendon forces
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4-corner arthrodesis and proximal row carpectomy: A biomechanical comparison of wrist motion and tendon forces

机译：4-角关节固定术和近端行鲤鱼切除术：腕部运动和肌腱力的生物力学比较

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Purpose: Controversy exists as to whether a proximal row carpectomy (PRC) is a better procedure than scaphoid excision with 4-corner arthrodesis for preserving motion in the painful posttraumatic arthritic wrist. The purpose of this study was to determine how the kinematics and tendon forces of the wrist are altered after PRC and 4-corner arthrodesis. Methods: We tested 6 fresh cadaver forearms for the extremes of wrist motion and then used a wrist simulator to move them through 4 cyclic dynamic wrist motions, during which time we continuously recorded the tendon forces. We repeated the extremes of wrist motion measurements and the dynamic motions after scaphoid excision with 4-corner arthrodesis, and then again after PRC. We analyzed extremes of wrist motion and the peak tendon forces required for each dynamic motion using a repeated measures analysis of variance. Results: Wrist extremes of motion significantly decreased after both the PRC and 4-corner arthrodesis compared with the intact wrist. Wrist flexion decreased on average 13° after 4-corner arthrodesis and 12° after PRC. Extension decreased 20° after 4-corner arthrodesis and 12° after PRC. Four-corner arthrodesis significantly decreased wrist ulnar deviation from the intact wrist. Four-corner arthrodesis allowed more radial deviation but less ulnar deviation than the PRC. The average peak tendon force was significantly greater after 4-corner arthrodesis than after PRC for the extensor carpi ulnaris during wrist flexion-extension, circumduction, and dart throw motions. The peak forces were significantly greater after 4-corner arthrodesis than in the intact wrist for the extensor carpi ulnaris during the dart throw motion and for the flexor carpi ulnaris during the circumduction motion. The peak extensor carpi radialis brevis force after PRC was significantly less than in the intact wrist. Conclusions: The measured wrist extremes of motion decreased after both 4-corner arthrodesis and PRC. Larger peak tendon forces were required to achieve identical wrist motions with the 4-corner arthrodesis compared with the intact wrist. We observed smaller forces for the PRC. Clinical relevance: These results may help explain why PRC shows early clinical improvement, yet may lead to degenerative arthritis.
机译：目的：关于在创伤后关节炎的手腕中保持运动，近端行鲤鱼切除术（PRC）是否比带四角关节固定术的舟骨切除术更好的手术方法存在争议。这项研究的目的是确定在PRC和4角关节固定术后腕的运动学和肌腱力如何改变。方法：我们测试了6个新鲜的尸体前臂的腕部运动极限，然后使用腕部模拟器通过4次周期性的动态腕部运动来移动它们，在此期间我们连续记录了肌腱力。我们在进行舟角切除术并使用4角关节固定术后重复了腕部运动测量和动态运动的极限，然后在PRC之后再次进行了测量。我们使用方差的重复测量分析来分析腕部运动的极限以及每种动态运动所需的峰值肌腱力。结果：与完整手腕相比，PRC和4角关节固定术后，腕关节的极限运动明显减少。腕关节屈曲平均在4个角关节固定后降低13°，在PRC后平均降低12°。 4角关节固定后延伸降低20°，PRC后延伸降低12°。四角关节固定术可显着降低腕尺与完整腕的尺偏。与中国相比，四角关节固定术允许更大的径向偏差，但尺骨偏差较小。在腕关节屈伸，外旋和飞镖运动期间，四角关节固定术后的平均峰值肌腱力明显大于尺骨腕腕的PRC。在四角关节固定术之后，在掷镖动作中，腕伸腕和尺骨腕屈肌的峰值力明显大于完整腕部。 PRC后的最大伸腕腕radial短肌力明显小于完整手腕。结论：在四角关节固定术和PRC后，测得的腕部极限运动降低。与完整的手腕相比，使用4角关节固定术需要更大的峰值肌腱力才能实现相同的手腕运动。我们观察到中国的部队较小。临床意义：这些结果可能有助于解释为什么PRC显示早期临床改善，但可能导致退行性关节炎。

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