Carpal instability after partial trapeziectomy, total trapeziectomy and the resection of the distal scaphoid pole: a cadaveric study,Archives of Orthopaedic and Trauma Surgery

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Carpal instability after partial trapeziectomy, total trapeziectomy and the resection of the distal scaphoid pole: a cadaveric study
Archives of Orthopaedic and Trauma Surgery ( IF 2.0 ) Pub Date : 2023-12-21 , DOI: 10.1007/s00402-023-05134-z
Leo Paeffgen ₁ , Janina Riederer ₁ , Tom Adler ₂ , Esther Voegelin ₁ , Luzian C P Haug ₁

Affiliation

Introduction

Non-dissociative carpal instability (CIND) may lead to severe functional impairment. Destabilisation of the scapho-trapezial-trapezoidal (STT) ligament complex seems to result in a CIND.

Materials and methods

In one group with eight cadaver arms, distal scaphoid pole was resected with the adjacent ligaments. In the other eight cadavers, hemitrapeziectomy was performed followed by total trapeziectomy. CT scans were performed in different wrist positions, and the changed positions of the scaphoid, lunate and capitate were measured in comparison to non-operated wrists.

Results

Mainly in clenched fist position, dissociation between proximal and distal row can be determined after total trapeziectomy and resection of distal scaphoid pole. Capitate rotates dorsally up to 24°, the scaphoid up to 17° and the lunate up to 7° compared to the non-operated wrists. Resection of the distal scaphoid pole results in dorsal rotation of capitate and scaphoid of about 14° and the lunate 8°. Relative scapholunate and capitolunate angle increased significantly after total trapeziectomy, especially in clenched fist position. After scaphoid pole resection, significant SL and CL angles changes could be seen in almost every wrist position.

Conclusion

Destabilisation of the STT ligament complex by total trapeziectomy or distal scaphoid pole resection results in dissociation of the proximal and distal carpal row without instability within the proximal or distal row, corresponding to a CIND.

Level of evidence

III.

中文翻译：

部分斜方肌切除术、全斜方肌切除术和远端舟骨极切除术后腕骨不稳定：一项尸体研究

介绍

非解离性腕骨不稳定（CIND）可能导致严重的功能障碍。舟骨-梯形-梯形 (STT) 韧带复合体的不稳定似乎会导致 CIND。

材料和方法

在一组有八具尸体手臂的情况下，远端舟状骨杆与邻近的韧带一起被切除。在另外八具尸体中，先进行了半梯形切除术，然后进行了全梯形切除术。在不同的手腕位置进行CT扫描，并与未手术的手腕相比，测量舟骨、月骨和头状骨的位置变化。

结果

主要以握拳位为主，在梯形全切除和舟骨远端切除后可确定近、远排分离。与未手术的手腕相比，头状骨背侧旋转最多 24°，舟状骨最多旋转 17°，月骨最多旋转 7°。远端舟骨极的切除导致头状骨和舟状骨背侧旋转约14°，月骨旋转8°。全梯形切除术后相对舟月骨和头月骨角度显着增加，尤其是在握拳位置时。舟骨极切除后，几乎每个手腕位置都可以看到显着的 SL 和 CL 角度变化。