背侧入路切开复位治疗经舟骨月骨周围背侧脱位

摘要

Objective To evaluate the clinical outcome of dorsal transscaphoid perilunate fracture-dislocations treated with screw fixation of the scaphoid and repair of the lunotriquetral interosseous ligament with bone anchors. Methods 13 cases with dorsal transscaphoid perilunate fracture-dislocations were treated with screw fixation of the scaphoid and repair of the lunotriquetral interosseous ligament with bone anchors. All cases were given X-ray film in PA view, lateral view and axial view of scaphoid at the follow-up. Assessment criteria included subjective assessment of pain, visual analogue scale( VAS ), range of motion( ROM ),grip power, Cooney wrist score and time of scaphoid union. Results The follow-up periods were 13 -24 months. The VAS score was 0 ～6( 1. 8 ±0. 9 ). Pain disappeared in 9 cases. ROM of flexion and extension at injured wrist was 73. 9% of opposite side; ROM of radial and ulnar deviation at injured wrist was 74. 1% of opposite side. Grip power was 91. 1% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 9, fair in 2 and poor in 1. Union of the scaphoid was attained in 12 ～ 18 weeks in 10 cases. Delayed union of the scaphoid was 30 -39 weeks in 3 cases. Conclusions Screw fixation of the scaphoid and repair of the lunotriquetral interosseous ligament with bone anchors is an effective method for dorsal transscaphoid perilunate fracture-dislocations when we can diagnose it in early time.%目的 评价切开复位螺钉固定舟骨、锚钉修复月三角韧带治疗急性期经舟骨月骨周围背侧脱位的临床疗效.方法 采用背侧入路切开复位螺钉固定舟骨、锚钉修复月三角韧带治疗13例经舟骨月骨周围背侧脱位患者.末次随访时进行评估:疼痛视觉模拟评分(VAS)、腕部活动度(ROM)、握力、Cooney腕关节评分、舟骨愈合情况.结果 13例均获随访,时间13～24个月.VAS评分0～6(1.8±0.9)分,其中9例患腕基本无疼痛.患腕屈伸ROM和尺桡偏ROM分别为对侧的73.9%和74.1%.患腕握力达对侧的91.1%.末次随访时Cooney评分:优1例,良9例,可2例,差1例.舟骨骨折愈合时间10例为12～18周,3例为30～39周.结论 经舟骨月骨周围背侧脱位早期诊断、早期手术,采用背侧入路切开复位内固定舟骨、修复月三角骨间韧带,可取得满意的临床效果.