经舟骨月骨周围腕骨脱位13例分析

目的 探讨经舟骨月骨周围腕骨脱位的诊断和治疗。方法 回顾性分析13例经舟骨月骨周围腕骨脱位病例 ,背侧型12例 ,掌侧型1例 ;其中7例系新鲜损伤 ,余6例为陈旧性 ;4例伴正中神经损伤 ,其中3例见于陈旧性组。新鲜损伤组6例手法闭合复位成功 ,仅1例因舟骨对位不良接受手术治疗 ;陈旧性组均接受手术 ,4例行开放复位内固定 ,1例行近排腕骨切除术 ,另1例行桡腕关节融合术。结果随访12例中11例 (91.67 % )获得满意疗效 ,陈旧性组1例造成舟骨远端缺血性骨坏死 ,3例遗留正中神经损害症状。结论 经舟骨月骨周围腕骨脱位的早期治疗简单且疗效较好 ,而一旦误诊 ,则多数需手术治疗 ,且残留不同程度的功能障碍。提高对本病损伤机制、腕部体征和影像学特点的认识和了解 ,减少误诊 ,是提高本病预后的关键因素之一。

Objective To analyze the diagnosis and treatment on trans-scaphoid perilunar dislocation(TSPD). Methods Between 1994 and 2000, 13 TSPD of the carpus had been treated. One case of 13 was a palmar TSPD and the others were dorsal TSPD. Early reduction by closed manipulation was done successfully in 6 cases of 7 fresh injury, open reduction and internal fixation was performed in one for inaccurate reduction of the scaphoid fracture. Open reduction and internal fixation (4 cases), proximal row carpectomy (1 case) and arthrodesis of the wrist (1 case) were performed in 6 cases of old injury. Results 12 of 13 patients were followed up for 8 months to 4 years (average follow-up time 25 months). The evaluation of the results by the Cooney WP clinical scale revealed excellent in 11 cases (91.67%), one case of distal avascular necrosis of scaphoid and 3 cases of median nerve injury were retained in old TSPD. Conclusion The early treatment of TSPD is simple and has ideal prognosis, which is different from old TSPD. It is very important to comprehend the injury mechanism, signs of wrist and the roentgenographic features of TSPD.