CAJ | 학술논문

目的评价应用镍钛记忆合金腕骨四角融合器(NiTi shape memory alloy four-corner arthrodesis concentrator,NTMA-FCAC)治疗腕塌陷(carpal collapse)的效果.方法 2006年8月至2009年6月,应用NTMA-FCAC行头骨、月骨、三角骨及钩骨四角融合并舟骨切除术治疗13例腕塌陷患者,男8例,女5例;年龄23～61岁,平均38岁;右手9例,左手4例.其中陈旧性舟骨骨折不愈合致腕塌陷7例,陈旧性经舟骨、月骨周围脱位致腕塌陷5例,舟月进行性腕塌陷1例.随访内容包括术后患手握力、腕关节活动范围、腕关节疼痛程度、腕关节X线检查.采用疼痛视觉模拟评分(visual analogue scale,VAS)评估腕关节疼痛程度.采用Krimmer腕关节评分对腕关节总体功能进行评价.结果术后随访6～36个月,平均26.5个月.术后平均握力为(32.49±6.21)kg,恢复至健侧的80.8%;术后腕关节活动范围达到健侧的53%以上.X线检查未见骨不连及伤口感染.腕关节VAS评分:休息状态下术前为(4.46±1.27)分,术后为(1.31±0.95)分;负重状态下术前为(7.00±1.41)分,术后为(2.62±1.26)分;两种状态下术前及术后比较,差异均有统计学意义.Krimmer腕关节评分为79分.术后优良率为84.6%.结论应用NTMA-FCAC进行四角融合术能保存大部分腕关节功能,是治疗腕塌陷的有效办法.
목적 평개응용얼태기억합금완골사각융합기(NiTi shape memory alloy four-corner arthrodesis concentrator,NTMA-FCAC)치료완탑함(carpal collapse)적효과.방법 2006년8월지2009년6월,응용NTMA-FCAC행두골、월골、삼각골급구골사각융합병주골절제술치료13례완탑함환자,남8례,녀5례;년령23～61세,평균38세;우수9례,좌수4례.기중진구성주골골절불유합치완탑함7례,진구성경주골、월골주위탈위치완탑함5례,주월진행성완탑함1례.수방내용포괄술후환수악력、완관절활동범위、완관절동통정도、완관절X선검사.채용동통시각모의평분(visual analogue scale,VAS)평고완관절동통정도.채용Krimmer완관절평분대완관절총체공능진행평개.결과 술후수방6～36개월,평균26.5개월.술후평균악력위(32.49±6.21)kg,회복지건측적80.8%;술후완관절활동범위체도건측적53%이상.X선검사미견골불련급상구감염.완관절VAS평분:휴식상태하술전위(4.46±1.27)분,술후위(1.31±0.95)분;부중상태하술전위(7.00±1.41)분,술후위(2.62±1.26)분;량충상태하술전급술후비교,차이균유통계학의의.Krimmer완관절평분위79분.술후우량솔위84.6%.결론 응용NTMA-FCAC진행사각융합술능보존대부분완관절공능,시치료완탑함적유효판법.
Objective To evaluate the results of NiTi shape memory alloy four-corner arthrodesis concentrator (NTMA-FCAC) for carpal collapse. Methods We reviewed retrospectively 13 patients who underwent scaphoid excision with four-corner arthrodesis using NTMA-FCAC for carpal collapse from August 2006 to June 2009. There were eight males and five females, with an average age of 38 years (range, 23-61years). The cause of carpal collapse was SNAC in 7 cases, perilunate dislocations in five and SLAC in one.The injury mechanisms included traffic accidents (5 cases), falling from a height (4 cases), crashes (3 cases)and sprain (1 case). Objective measurements included grip strength and range of the wrist. Radiographs were performed in all patients. A visual analogue scale (VAS) was used to assess wrist pain. The results were evaluated according to the Krimmer wrist scores. Results The mean follow-up time was 26.5 months (range,6-36 months). Clinical evaluation yielded the mean grip strength of (32.49±6.21) kg (80.8% of opposite side).The mean range of the wrist reached over 53% of the healthy side. Non-union and wound infection were not seen. The mean VAS scores had improved from 4.46±1.27 preoperatively to 1.31 ±0.95 postoperatively. The mean pain scores under stress had improved from 7.00±1.41 preoperatively to 2.62±1.26 postoperatively.There were remarkable differences between them. The mean Krimmer wrist score was 79. Conclusion Four-corner arthrodesis using NTMA-FCAC is an effective method for carpal collapse, preserving a majority of wrist function.