桡骨远端骨折合并月骨脱位的治疗

Management of distal radius fracture accompanied with lunate dislocation

目的探讨桡骨远端骨折伴月骨脱位的治疗方法。方法2001年1月-2006年6月。对28例桡骨远端骨折伴月骨脱位的患者。其中新鲜损伤16例，采用手法复位石膏固定6例。微创撬拨复位、克氏针加石膏固定10例。陈旧性损伤12例，采用保守治疗后月骨再脱位3例。月骨漏诊9例；其中4例行掌侧入路月骨复位术，克氏针加石膏固定。8例行背侧入路月骨复位术，修复桡月背侧韧带，克氏针加石膏固定。腕关节功能按Lidstrom评分标准评定及腕部X线片检测有无月骨坏死。结果术后28例获得随访时间为1-4年（平均2．2年），腕关节功能评分：新鲜损伤组优良率为93．8％，陈旧性损伤组优良率为75．0％。腕部X线片显示：新鲜损伤组月骨坏死率为0。陈旧损伤组月骨坏死率为25．0％。陈旧性损伤组掌侧切口入路月骨坏死率为50．0％，背侧入路月骨坏死率为12．5％。结论桡骨远端骨折伴月骨脱位的治疗关键在于及时诊断和处理月骨脱位。避免发生陈旧性月骨脱位。后者手术以背侧入路复位固定并同时修复桡月背侧韧带为宜。

Objective To explore the treatment options for distal radius fracture accompanied with lunate dislocation. Methods From January 2001 to June 2006, 28 cases of distal radius fractures accompanied with lunate dislocation were treated. There were 10 females and 18 males. Their ages ranged from 18 years to 65 years. Sixteen cases were fresh injuries, while 12 cases were old injuries. Among patients with fresh injuries, 6 cases were treated close reduction and plaster fixation. Ten cases were treated with miniinvasive leverage reduction followed by Kirschner wire and plaster fixation. Among patients with old injuries, 3 cases had lunate reislocation after conservative treatment. Lunate dislocation was not initially diagnosed in the rest 9 cases. Four of those cases underwent surgical reduction and Kirschner wire pinning of the lunate via a palmar approach and plaster fixation. Eight cases had surgical reduction of the lunate and dorsal radiolunate ligament repair via a dorsal approach and fixation with Kirschner wire and plaster. Follow-up ranged from 1 to 4 years （ average 2. 2 years）. Wrist function was evaluated using Lidstrom score. Lunate necrosis was detected by X ray. Results Excellent and good rate was 93.8% in fresh injury cases and 75.0% in old injury cases as graded by Lidstrom wrist function scores. The lunate necrosis rate was 0 in fresh injury cases and 25.0% in old injury cases. Among old injury cases, the lunate necrosis rate was 50.0% in cases treated via the palmar approach and 12.5% in those treated via the dorsal approach. Conclusion Proper diagnosis and prompt treatment of lunate dislocation is key to the treatment of distal radius fractures accompanied with lunate dislocation. Once old lunate dislocation exists, surgical reduction of the lunate via a dorsal approach along with dorsal radiolunate ligament repair is the procedure of choice.