桡骨远端骨折合并腕关节韧带损伤的关节镜观察

Arthroscopie findings of wrist ligament injuries associated with distal radius fractures

目的介绍桡骨远端骨折时，腕关节韧带（舟月骨间韧带、月三角韧带和三角纤维软骨复合体）损伤的关节镜观察。方法对27例桡骨远端骨折，采用腕关节镜辅助治疗，观察舟月骨间韧带、月三角韧带和三角纤维软骨复合体的损伤情况，通过Geissler腕部韧带损伤等级分型方法和Palmer方法记录损伤级别。采用卡方检验，分析腕关节韧带损伤程度与骨折类型之间的关系。结果27例腕关节镜下观察均出现舟月骨间韧带、月三角韧带损伤，损伤为Ⅰ～Ⅱ级；25例有三角纤维软骨复合体损伤，损伤大多为Ⅰa型；腕部韧带损伤的程度与骨折的分型无显著关系。结论桡骨远端骨折时，腕部韧带损伤率较高，采用腕关节镜辅助治疗专利于准确发现腕部韧带的损伤。

Objective To report the incidence and extent of injuries of the scapholunate interosseous ligament （SLIL）, lunotriquetral interosseous ligament （LTIL） and triangular fibrocartilage complex （TFCC） observed under wrist arthroscope during treatment of distal radius fractures. Methods Twenty-seven cases of distal radius fractures were treated with wrist arthroscopic assistance. Distal radius fractures were categorized using AO classification. Injuries of SLIL and LTIL were viewed and graded by Geissler＇s arthroscopie classification of carpal instability/interearpal ligament injuries. TFCC lesions were recorded by Palmer＇ s classification. Chi square statistical analysis was used to analyze the relationship between the extent of these ligament injuries and the types of distal radius fractures. Results All 27 cases had SLIL and LTIL injuries of grade Ⅰ to grade Ⅱ. 25 cases had type Ia TFCC lesions. There was no significant correlation between ligament injuries and the types of fractures. Conclusion There is a high incidence of ligament injury accompanying distal radius fractures. Wrist arthroscope assisted treatment of distal radius fractures can enhance the accurate detection of these carpal ligament injuries.