Alternative Title橈骨舟状骨月状骨固定に追加する舟状骨遠位切除及び三角骨切除が手関節ダーツスロー運動とぶんまわし運動に与える生体力学的効果
Periodical titleThe Journal of hand surgery
Note (General)type:Thesis
Purpose: Distal scaphoid and triquetrum excisions can improve the range of wrist motion after radioscapholunate (RSL) fusion, but little is known about the kinematics of dart-throwing and global circumduction motions. We hypothesized that these excisions could increase the range of motion without causing midcarpal instability. Methods: Seven fresh-frozen cadaver upper extremities were mounted on a testing apparatus after isolation and preloading of the tendons of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, and extensor carpi ulnaris. Sequential loadings of the flexor carpi ulnaris and extensor carpi radialis simulated active dart-throwing motion. Passive circumferential loading produced the wrist circumduction motion. We measured the range of wrist motions with an electromagnetic tracking system in 4 experiments: intact, simulated RSL fusion, RSL fusion with distal scaphoid excision, and RSL fusion with distal scaphoid and total triquetrum excisions. To evaluate midcarpal stability, we conducted passive mobility testing of the distal carpal row in the radial, volar, ulnar, and dorsal directions. Results: Radioscapholunate fusion decreased the dart-throwing motion to a mean of 46% of the baseline value; distal scaphoid and triquetrum excisions increased the mean arc to 50% and 62%, respectively. Radioscapholunate fusion diminished the wrist circumduction to a mean of 43% of the baseline value, which increased to a mean of 58% and 74% after distal scaphoid and triquetrum excision, respectively. A significant increase in radial deviation was noted after distal scaphoid excision, and subsequent triquetrum excision significantly increased motion in the ulnar-palmar direction. Regarding midcarpal stability, dorsal translation significantly increased after distal scaphoid and triquetrum excisions. Conclusions: Distal scaphoid and triquetrum excision after RSL fusion improved both dart-throwing and circumduction motions, but dorsal midcarpal instability occurred. Clinical relevance: Subsequent carpal excisions may improve short-term outcome by increasing motions in a RSL-fused wrist; however, a potential risk of midcarpal instability should be considered.
博士（医学）・甲第757号・令和2年12月24日
Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
identifier:The Journal of hand surgery Vol.46 No.1 p.71.e1-71.e7 (2021 Jan)
identifier:03635023
identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3815
identifier:The Journal of hand surgery, 46(1): 71.e1-71.e7
DOIinfo:doi/10.1016/j.jhsa.2020.08.009
Collection (particular)国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文
Date Accepted (W3CDTF)2021-05-23T18:24:43+09:00
Data Provider (Database)国立国会図書館 : 国立国会図書館デジタルコレクション