锚钉韧带重建在经桡骨月骨周围脱位治疗中的应用

Ligament reconstruction using rivet for treatment of trans-radius perilunar dislocations

目的探讨锚钉韧带重建在经桡骨月骨周围脱位治疗中的应用。方法自2007年2月至2014年5月，我们对9例经桡骨月骨周围脱位患者进行切开复位内固定，根据不同分型应用锚钉进行不同的韧带修复重建手术治疗，术后测量患者腕关节活动度和握力，复查腕关节X线正侧位片了解骨折愈合情况及有无创伤性关节炎发生，选用Mayo腕关节评分法评估患者治疗效果。结果本组中Ⅰ型4例，Ⅱ型4例，Ⅲ型1例，其中3例X线片初始报告未做出正确诊断。术后随访时间为10-26个月，平均18个月。Mayo腕关节评分评估结果：优3例，良4例，可2例。末次随访时患侧腕关节平均屈伸活动度为109．4°，平均握力相当于健侧的84．2％。腕关节活动时仍有2例遗留轻度疼痛，1例出现月骨无菌性坏死，未出现骨不连及创伤性骨关节炎。结论锚钉韧带重建治疗经桡骨月骨周围脱位，术后可以获得良好的治疗效果。

Objective To evaluate application of rivet for ligament reconstruction in the treatment of trans-radius perilunar dislocations （TRPD）. Methods From February 2007 to May 2014, 9 cases of TRPD were treated. They were divided into three types according to the fracture site： type Ⅰ for dorsal radius, type Ⅱ for radial styloid, type Ⅲ for dorsal radius and radial styloid. All 9 patients were surgical treated using rivet for ligament reconstruction. Patients were evaluated postoperatively by measuring the range of motion of the wrist and grip strength, wrist radiography for fracture healing and signs of post- traumatic arthritis. The Mayo wrist score was assessed. Results There were 4 cases of type Ⅰ, 4 cases of type Ⅱ and 1 case of type Ⅲ. The first radiography diagnosis was inaccurate in 3 cases. Surgical open reduction, internal fixation and ligament repair were carried out in aU patients under brachial plexus block. All patients were follow-up for 10 to 26 months with a mean period of 18 months. The final outcome was excellent in 3 cases, good in 4, and fair in 2 according to the Mayo wrist score. The average range of flexion and extension motion was 109.4°and the mean grip strength was 84.2% of the uninjured wrist. Two patients suffered slight pain. Aseptic necrosis of the lunate occurred in 1 case. No post-traumatic arthritis and nonunion were present on X-rays. Conclusion Ligament reconstruction using rivet can achieve a satisfactory outcome for treatment of trans-radius perilunar dislocations.