经舟骨月骨周围脱位早期诊断和手术的重要性

Importance of early diagnosis and operative treatment for trans-scaphoid perilunate dislocation

目的:评价切开复位内固定同时修复损伤韧带治疗经舟骨月骨周围脱位重要性。方法:1995年6月至2001年6月,采用切开复位内固定同时修复损伤韧带治疗14例经舟骨月骨周围脱位患者,其中男13例,女1例;年龄21～38岁,平均25.4岁。手术均在受伤后2周内进行,所有患者均为后脱位。结果:14例患者均获得随访,时间24～60个月,平均28.3个月。13例舟骨骨折一期愈合,腕关节功能恢复良好;1例出现骨不连,腕关节功能部分受限。未发现舟骨和月骨坏死者。采用Cooney评分法:优9例,良3例,可1例和差1例。结论:对于经舟骨月骨周围脱位患者,如能得到早期诊断,采取早期复位及切开内固定治疗,同时修复损伤的腕掌侧关节囊、桡舟头韧带和桡舟月韧带,可早期提供腕舟骨稳固的固定,有利于舟骨近段和月骨血供的恢复。

Objective：To evaluate the effectiveness of open reduction and internal fixation and repair of palmar ligment in treating trans-scaphoid perilunate dislocation. Methods：From June 1995 to June 2001,14 patients with trans-scaphoid perilunate dislocation were treated with open reduction and internal fixation and repair of palmar ligment. Among them,there were 13 males and 1 female,the ranging in age from 21 to 38 years,averaged 25.4 years. All patients were posterior dislocation and all operations were performed within 2 weeks after injury. Results：All patients were followed up from 24 to 60 months with an average of 28.3 months. Thirteen scaphoid fractures were primary healed and functions of wrist joint were good. Bone disunion was found in 1 case and part functions of wrist joint were limited. No found necrosis of lunate and scaphoid. According to clinical scoring system of Cooney,9 case got excellent results,3 good,1 fair and 1 poor . Conclusion：Open reduction and internal fixation and repair of palmar ligament is effective in treating trans-scaphoid perilunate dislocation,which can early provide steady fixation for scaphoid,and profit to recover blood supply of lunatum and subterminal scaphoid.