复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位  

Open reduction and internal fixation combined with intercarpal ligament repair for the treatment of acute perilunate transscaphoid fracture dislocations or perilunate dislocations

作　　者：梅国华[1] 范存义[1] 柴益民[1] 孙鲁源[1] 王挺[1] 曾炳芳[1] 

机构地区：[1]上海市第六人民医院骨科,200233

出　　处：《中华手外科杂志》2010年第3期175-178,共4页Chinese Journal of Hand Surgery

摘　　要：目的总结切开复位内固定联合腕骨间韧带修补治疗急性经舟骨骨折月骨周围脱位或经月骨周围脱位的疗效。方法2004年2月至2006年8月共收治12例月骨周围损伤的患者，其中8例经舟骨骨折月骨周围脱位，4例月骨周围脱位。全部采用切开复位，3．0m／nAO空心螺纹钉或通用公司Bold钉固定舟骨骨折，克氏针固定腕骨间关节，并使用Mitek锚钉修补腕骨间韧带。结果术后平均随访时间为37个月（33～48个月），X线片显示所有舟骨骨折均愈合，舟月角平均50°（35°～65°），桡月角平均5°（-10°-15°），腕骨高度指数平均0．51（0．50～0．53）。临床检查腕关节活动度平均为92．5°，握力达健侧的76．7％，腕关节无痛者8例、轻痛者2例、中度疼痛者2例。按照改良Mayo腕关节评分法平均为72分（50—95分），其中极好1例、好4例、可4例、差3例。结论早期切开复位治疗月骨周围损伤可获得较满意的腕关节功能，结合韧带修补可防止腕骨间不稳以及继发的腕关节塌陷。Objective To evaluate the results of open reduction and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilanate dislocations. Methods From February 2004 to August 2006, 12 cases of perilunate fracture dislocations or perilunate dislocations were treated operatively, in which 8 cases were transscaphoid fracture dislocations and 4 eases were perilunate dislocations. All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws, with the seapholunate or lunotriquertral ligaments sutured by Mitek mini suture anchors. Results All cases were followed up for a mean period of 37 months （from 33 to 48 months）. All the scaphoid healed primarily, the height of the carpal was maintained well with a mean scapho-lunate angle of 50° （35° to 65°） ,mean radio-ltmate angle of 5°（ - 10° to 15°）, the mean index of carpal height was 0.51 （0.50 to 0.53）, the ROM of the wrist is about 92.5°, The grip strength was 76.7% of the contralateral side. The modified Mayo wrist score revealed 1 excellent, 4 good, 4 fair and 3 poor results. The average score was 72（50 to 95）. Conclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture dislocations or perilunate dislocations. Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments repair in short term.

关 键 词：舟骨 骨折固定术 内 修复外科手术 月骨周围脱位 

分 类 号：R687.3[医药卫生—骨科学]