月骨周围掌侧骨折脱位

Volar perilunate fracture-dislocation

目的 探讨月骨周围掌侧骨折脱位的临床表现及治疗结果。方法 对5例腕部复合损伤造成月骨周围掌侧骨折脱位的患者，其中2例（急性开放损伤）采用清创术，腕骨骨折脱位复位后予克氏针内固定或前臂外固定支架固定；3例为陈旧性损伤，行近排腕骨切除，其中2例同时行骨间背侧神经切除。结果5例随访时间平均为14.4个月。术后腕关节主动运动功能为掌屈15°-40°，平均20°；背伸20°-50°，平均35°；桡偏5°-10°，平均8°；尺偏10°-20°，平均12°。3例日常活动时腕关节疼痛，4例握物时力弱，1例X线片发现有舟月骨间分离；1例术后6个月重返原工作岗位，余4例仍残留其他部分功能障碍需进一步治疗。结论 月骨周围掌侧骨折脱位由直接暴力作用所引起，临床易引起漏诊。由于损伤暴力大，常造成开放性多组织复合损伤，延误诊断是导致疗效不满意的主要原因。

Objective To explore the clinical presentation and treatment outcome of voler perilunate fracture-dislocation.Methods Of the 5 cases,open recuction and fixation with Kirschner wire or external fixator fixation were performed on 2 cases in the aoute stage,proximal row carpectomy was performed on 3 cases in the late stage.Results The avceage follow-up period was 14.4 months.The average flextion-cxetntion and radial-ulnar deviation are with injreied wrist were 20°-35° and 8°-12°,respectively.Wrist pain during the daily work was found in 3 cases,weakness of gripping objects in 4 cases,and scapholunate dissociation in 1 case.Conclusion Direot trauma with high energy causes the voler perilunate fracture-dislocation which the diagnosis is often missed.High energy traums ,open and complex injury and delayed diagnosis make the treatment outcome unsatisfied.