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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2021; 49(02): e105-e114
DOI: 10.1055/s-0041-1739239
Original Article

Artrodesis de cuatro esquinas con placa circular dorsal bloqueada versus tornillos canulados de compresión sin cabeza: estudio clínico-radiológico comparativo

Article in several languages: English | español
Francisco R. Melibosky 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Rene A. Jorquera 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Felipe Z. Saxton 
2   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
,
Pablo Orellana 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Diego Junqueras 
2   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
3   Hand Surgery Unit, Department of Traumatology and Orthopedics, Hospital de la Florida, Santiago, Chile
,
Camila Azócar 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
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Resumen

Introducción La artrodesis de cuatro esquinas es una técnica para el tratamiento de colapsos avanzados del carpo. Consiste en realizar una escafoidectomía asociada a artrodesis de los huesos semilunar, piramidal, ganchoso y grande. La cirugía se puede realizar con distintos tipos de osteosíntesis. En los primeros reportes de uso de las placas circulares dorsales, se describen malos resultados, con altas tasas de no unión, las cuales disminuyeron en los estudios posteriores, en los cuales se pone especial hincapié en puntos de la técnica quirúrgica.

Objetivo Reportar nuestra experiencia en la artrodesis de cuatro esquinas con el uso de una placa dorsal bloqueada (Xpode, Trimed Inc., Santa Clarita, CA, EEUU), y compararla con otro método de fijación tradicional (tornillos canulados de compresión sin cabeza de 3.0 mm, Synthes, Solothurn, Suiza), con énfasis en la consolidación, evaluación de resultados funcionales, y presencia complicaciones.

Material y Métodos Estudio comparativo de dos series de pacientes operados con dos técnicas distintas de osteosíntesis para una artrodesis de cuatro esquinas utilizando injerto autólogo de cresta iliaca.

En un primer grupo, evaluado entre el 2010 y el 2012, se usó osteosíntesis con 2 tornillos canulados de compresión sin cabeza, con un seguimiento mínimo de 18 meses, y en otro grupo, evaluado entre el 2011 y el 2014, se usó osteosíntesis con placa bloqueada dorsal, con un seguimiento mínimo de 12 meses. Estos fueron operados en cuatro centros por cuatro cirujanos distintos.

Se les evaluó con radiografías, para determinar la presencia de consolidación y el tiempo de la misma. En caso de duda, se certificó la consolidación con tomografía axial computarizada (TAC), a las ocho semanas postquirúrgicas. También se evaluaron los rangos de movimiento, la presencia de complicaciones, y la función con escalas las escalas de discapacidades del brazo, hombro y mano (Disabilities of the Arm, Shoulder and Hand, DASH, en inglés), y de fuerza de puño.

Resultados Logramos tasas de consolidación del 100% en ambos grupos, con tiempos similares. Destaca en el grupo de placas el mejor rango de movimiento total y en especial de la extensión, con una diferencia estadísticamente significativa (p = 0,0016), al igual que la obtención de puntajes de DASH más bajos, con una diferencia estadísticamente significativa (p = 0,0066). Sólo en el grupo de tornillos hubo dos casos de complicación de la osteosíntesis.

Conclusión Ambas técnicas son válidas y reproducibles para el tratamiento de las muñecas con colapso avanzado del carpo secundario a una lesión escafolunar (scapholunate advanced collapse, SLAC, en inglés) y colapso avanzado del carpo secundario a una no unión del escafoides (scaphoid non-union advanced collapse, SNAC, en inglés). Con base en los resultados, consideramos que, con la placa Xpode, los pacientes presentan mejores rangos de movimiento y puntajes en el DASH, por lo que puede ser una excelente alternativa para la artrodesis de cuatro esquinas con técnica abierta. La configuración y el sitio de entrada en el caso de usar tornillos son temas fundamentales a analizar.

La tasa de consolidación del 100% obtenida en este estudio contrasta con las altas tasas de no unión de las placas dorsales circulares reportadas en la bibliografía en los años 2000.

Palabras clave

SNAC - SLAC - artrodesis parcial del carpo - artrodesis de cuatro esquinas - placa bloqueada dorsal - tornillos canulados de compresión


Publication History

Received: 05 October 2020

Accepted: 09 June 2021

Article published online:
13 December 2021

© 2021. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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