经舟骨月骨周围脱位的早期手术治疗

目的 研究经舟骨月骨周围脱位早期复位并进行切开内固定和修复损伤的腕掌侧关节囊和韧带的治疗方法。方法 从1995年6月～2001年6月，共7例经舟骨月骨周围脱位患者接受这种治疗方法。手术均在受伤后2周内进行，所有患者均为后脱位。结果 7例都得到随访，平均随访时间20．5个月。6例舟骨骨折愈合，腕关节功能恢复良好；1例出现骨不连，腕关节功能部分受限。尚未发现月骨坏死者。采用Cooneyr评分法：优2例、良3例、可1例和差1例，优良率71．4％。结论 经舟骨月骨周围脱位应早期复位及切开内固定治疗，同时修复损伤的腕掌侧关节囊、桡舟头韧带和桡舟月韧带。可早期提供腕舟骨稳固的固定，有利于舟骨近段和月骨血供的恢复。     

早期切开复位Herbert螺钉内固定治疗经舟骨月骨周围脱位

目的 评价早期切开复位、Herbert螺钉内固定治疗经舟骨月骨周围脱位的临床效果.方法 早期采用切开复位、Herbert螺钉内固定治疗新鲜经舟骨月骨周围脱位8例,术后随访X线片了解骨折愈合情况及腕关节轴线恢复情况.Cooney腕关节评分法评价术后腕关节功能恢复程度,DASH问卷调查表行术后腕关节功能自我评价.结果 术后随访时间为7～35个月,平均14个月.根据Cooney腕关节评分:优3例,良2例,中2例,差1例;平均评分值为76.DASH评分值为27.X线片检查舟骨完全愈合,腕关节轴线恢复好.结论 早期切开复位Herbert螺钉内固定能达到舟骨解剖复位、恢复腕关节轴线,术后功能恢复较好,是治疗新鲜经舟骨月骨周围脱位较好的方法.     

经舟骨月骨周围骨折脱位的诊治分析

经舟骨月骨周围骨折脱位在腕部损伤中比较罕见,临床上容易误诊漏诊,笔者自1998年1月～2010年1月共收治8例此类骨折,现就其诊断和治疗进行探讨分析.1 临床资料 1.1 一般资料本组8例,男6例,女2例;年龄21～40岁,平均32.5岁.致伤原因:高处坠落伤4例,腕关节异常背伸致伤1例,骑摩托车摔伤2例,平地摔伤1例.右腕5例,左腕3例,合并桡骨茎突骨折2例,合并正中神经损伤2例.1例于伤后24d就诊,3例于伤后14～21 d就诊.     

经舟骨月骨周围脱位早期诊断和手术的重要性

目的：评价切开复位内固定同时修复损伤韧带治疗经舟骨月骨周围脱位重要性。方法：1995年6月至2001年6月,采用切开复位内固定同时修复损伤韧带治疗14例经舟骨月骨周围脱位患者,其中男13例,女1例;年龄21～38岁,平均25.4岁。手术均在受伤后2周内进行,所有患者均为后脱位。结果：14例患者均获得随访,时间24～60个月,平均28.3个月。13例舟骨骨折一期愈合,腕关节功能恢复良好;1例出现骨不连,腕关节功能部分受限。未发现舟骨和月骨坏死者。采用Cooney评分法：优9例,良3例,可1例和差1例。结论：对于经舟骨月骨周围脱位患者,如能得到早期诊断,采取早期复位及切开内固定治疗,同时修复损伤的腕掌侧关节囊、桡舟头韧带和桡舟月韧带,可早期提供腕舟骨稳固的固定,有利于舟骨近段和月骨血供的恢复。     

近排腕骨切除术治疗陈旧性经舟骨月骨周围骨折-脱位

目的报道近排腕骨切除术治疗陈旧性经舟骨、月骨周围脱位的临床效果。方法对 34例应用此手术的患者进行功能评价,平均随访5年3个月。结果29例腕部疼痛症状消失,5例仍有轻微腕部疼痛不适;腕关节屈伸活动度较术前增加了30°～50°;尺、桡偏活动较差,范围20°～30°;握力较健侧稍减弱;29例恢复了原来的工作,5例改为轻工作。结论近排腕骨切除术是治疗陈旧性经舟骨、月骨周围脱位的一种可靠有效的方法。     

陈旧性经舟骨月骨周围脱位的治疗

目的探讨两阶段治疗陈旧性经舟骨月骨周围脱位的疗效。方法2005年2月至2010年7月采用两阶段治疗8例陈1日性经舟骨月骨周围脱位患者,其中男7例,女1例;年龄18～38岁,平均年龄28岁。受伤至手术治疗时间平均4．5个月。第一阶段采用外固定器牵引,第二阶段进行切开复位内固定。结果本组均获随访,随访时间2．5～5．8年,平均4．2年。l临床评估采用腕关节Mayo评估,包括手腕疼痛、功能状态、运动范围和握力,主观评定疼痛分为永久性疼痛、日常生活偶有疼痛、活动时剧痛、无痛。本组优4例,良3例,一般I例。结论两阶段治疗方法治疗陈旧性经舟骨月骨周围脱位可操作性强,组织损伤小,疗效好。     

经舟骨月骨周围骨折脱位误诊的分析及治疗

腕关节是较为复杂的关节，参与腕关节构成的八块腕骨在受暴力作用下容易发生骨折脱位，且误诊率较高，尤其是经舟骨月骨周围骨折脱位。回顾我院2000年3月～2004年3月收治的陈旧性经舟骨月骨周围骨折脱位患者误诊5例，误诊率占同期此类病例的83．3％，要高于国内文献报道的早期误诊率66％～81.8％，现报道如下。     

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

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,3.0mm AO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Nitek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.     

Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate

The outcome of delayed treatment of an unreduced transscaphoid, transtriquetral, perilunate fracture dislocation of the carpus is unpredictable. Long-term follow-up observations in a 22-year-old man treated three months postinjury showed changes in the lunate consistent with avascular necrosis at the time of open reduction and internal fixation. Early resolution of this was evident by nine months, and complete resolution was seen at the follow-up examination (four years and two months). Despite delay in treatment, this patient had full, pain-free wrist motion. Consequently, avascular changes of the carpus following wrist dislocation do not preclude a good result. Anatomic reduction of the scaphoid, as well as the midcarpal joint, and restoration of the articular surface of the lunate, are most important in determining prognosis.     

早期手术治疗经舟骨月骨周围骨折脱位的临床分析

目的 评价早期手术治疗经舟骨月骨周围骨折脱位的临床疗效.方法 15例经舟骨月骨周围骨折脱位的患者,采用切开复位加压螺钉和克氏针内固定.术后评估腕部疼痛、腕关节活动度、手部握力及骨折愈合,并用腕关节Krimmer评分法评估疗效.结果 13例获得6～12个月随访,平均9个月.2例出现静息痛,3例活动时疼痛.腕关节屈伸活动度（65±11）°,尺桡偏角度为（10±8）°,平均握力较健侧减少10%.X片检查3例腕关节炎,2例舟骨骨折近端骨质吸收致舟骨不愈合.11例腕舟骨愈合,平均愈合时间为4.8个月.Krimmer评分法评估总体疗效：优7例,良1例,可3例,差2例.结论 早期切开复位应用克氏针和加压螺钉同时内固定治疗经舟骨月骨周围骨折脱住手术方式可行、疗效可靠.     

经舟状骨骨折的背侧型月骨周围脱位诊治体会

目的分析经舟状骨骨折的背侧型月骨周围脱位的X线表现。方法8例经舟状骨骨折的背侧型月骨周围脱位,均急诊在臂丛麻醉和透视下给予手法复位。结果8例全部1次性复位成功。随访6个月～3年,无一例发生骨坏死,腕部功能无丧失。结论熟悉腕关节的正常X线表现,了解各型腕部损伤的X线特点,是正确及时诊断、治疗该型损伤的基础。     

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

Objective To evaluate the results of Open reducdon and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilunate 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 cases were perilunate dislocations.All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws,with the scapholunate 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-lunate 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 Nayo wrist score revealed 1 excellent,4 good,4 fair and 3 poor results.The average score was 72(50to 95). Collclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture disloeations or perilunate dislocations.Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments rear in short term.     

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

Objective To evaluate the results of Open reducdon and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilunate 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 cases were perilunate dislocations.All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws,with the scapholunate 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-lunate 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 Nayo wrist score revealed 1 excellent,4 good,4 fair and 3 poor results.The average score was 72(50to 95). Collclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture disloeations or perilunate dislocations.Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments rear in short term.     

The direct,dorsal approach to the treatment of unstable tibial posteromedial fracture-dislocations

The surgical treatment of highly unstable tibial posteromedial fracture-dislocations (medial split fracture,Moore type I) is demanding and may cause significant problems. The anterior and the posteromedial approach require detachment of the medial capsuloligamental structures or arthrotomy of the knee joint. Neither of these operative techniques allow the optimal posterior positioning of the buttress plate in order to prevent caudal dislocation of the fragment during knee flexion. The published posterior approaches to the proximal tibia allow appropriate positioning of the anti-glide plate. However, these surgical exposures involve transsection of the semi-membranous and popliteal muscles as well as the partial dissection of the medial gastrocnemius muscle.We present a direct posterior approach and an operative treatment of medial split fractures with open reduction and internal fixation in a prone position. This position simplifies the reduction of the posteromedial fragment by hyperextension and axial traction, as well as osteosynthesis with lag screws and the placement of the buttress plate (radial T-plate). The surgical exposure requires minimal soft tissue dissection. The inferior spike of the fragment can be visualized by partial subperiosteal detachment the popliteal muscle,whereas the medial gastrocnemius muscle and the semi-membranous muscle are preserved. Due to the voluminous subcutaneous tissue in the posteromedial tibial aspect, the closure of the skin incision over the medial gastrocnemius muscle can be performed without difficulty. Three cases of tibial posteromedial fracture-dislocation were treated by the direct posterior approach in a prone position in January and February 2002. The present report shows that the direct posterior surgical technique allows optimal exposure, reduction and internal fixation of medial split fractures of the tibial plateau with minimal trauma.     

Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation

Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient''s wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid.     

Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations

PURPOSE: Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach. METHODS: A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture-dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws. RESULTS: A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70 degrees (range, 55 degrees -90 degrees ). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85 degrees , and the average PIP joint motion for the remaining 7 patients was 65 degrees . One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14 degrees . Seven patients had no pain, and 2 had pain only with heavy activity. CONCLUSIONS: Open reduction and internal fixation of unstable dorsal PIP joint fracture-dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.