掌侧入路治疗经舟骨月骨周围脱位的临床疗效  

Clinical efficacy of the treatment of perilunate dislocation of the scaphoid bone through volar approach

作　　者：顾加祥 刘宏君 张乃臣 张文忠 王天亮 Gu Jiaxiang;Liu Hongjun;Zhang Naichen;Zhang Wenzhong;Wang Tianliang(Department of Hand and Foot Microsurgery,Subei People′s Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院手足显微外科,扬州225001

出　　处：《中华手外科杂志》2023年第6期553-556,共4页Chinese Journal of Hand Surgery

摘　　要：目的了解掌侧入路切开复位内固定治疗经舟骨骨折月骨周围脱位(trans-scaphoid perilunate dislocation,TSPD)的临床效果。方法自2012年12月至2018年12月我们收治21例TSPD患者,根据受伤至手术时间分类:新鲜TSPD 18例,陈旧TSPD 3例;根据腕舟骨骨折Mayo分型:腰部骨折14例,远端关节面骨折3例,远端1/3骨折4例。均为背侧脱位,保守治疗失败后行手术切开复位内固定,术后记录平均手术时间、术中出血量、术后腕舟骨骨折愈合时间及术后12个月改良Mayo腕关节功能评分。结果手术时间平均70 min,术中出血量平均10 ml;腕舟骨骨折愈合时间为6~12周,平均8.0周,无月骨坏死发生;术后12个月Mayo腕关节功能评分平均90分。结论掌侧入路切开复位内固定治疗TSPD可获得较好的临床效果。Objective To analysis the clinical efficacy of open reduction and internal fixation through volar approach for the treatment of trans-scaphoid perilunate dislocation(TSPD).Methods From December 2012 to December 2018,21 TSPD patients were treated in our hospital.According to the time from injury to surgery,there were 18 fresh TSPD patients and 3 old TSPD patients.According to the Mayo classification of carpal scaphoid fractures,there were 14 cases of lumbar fractures,3 cases of distal articular surface fractures,and 4 cases of distal 1/3 fractures.All cases were dorsal dislocations,and after conservative treatment failed,surgical open reduction and internal fixation were performed.The average surgical time,intraoperative bleeding,postoperative healing time of scaphoid fractures,and improved Mayo wrist joint function score at 12 months after surgery were recorded.Results The average surgical time was 70 minutes,and the average intraoperative bleeding volume was 10 ml.The healing time of wrist scaphoid fracture was 6 to 12 weeks,with an average of 8.0 weeks,and there is no occurrence of lunate bone necrosis.The Mayo wrist joint function score averaged 90 points at 12 months after surgery.Conclusion The open reduction and internal fixation through volar approach can achieve good clinical results in the treatment of TSPD.

关 键 词：舟骨 骨折 脱位 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]