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。     

牵引推送手法复位塑形托板固定治疗经舟骨月骨周围脱位

经舟骨月骨周围脱位是腕部的一种严重损伤,在临床中比较少见,治疗难度较大,若治疗不及时或不当易造成腕关节不稳、腕关节功能障碍、舟骨及月骨发生缺血性坏死等不良后果[1-3].自2001年1月至2009年6月,采用牵引推送手法复位埋形托板外固定治疗经舟骨月骨周围脱位32例,取得满意疗效,现总结报告如下.     

陈旧性腕舟骨骨折手术治疗体会

腕舟骨骨折以往常采用手法复位、石膏或夹板外固定，发生骨折不愈合的病例较多。临床上陈旧性腕舟骨骨折的治疗方法较多，方法较复杂，创伤大。2003年7月至2005年6月收治陈旧性腕舟骨骨折22例，采用切开复位钢针内固定加取桡骨背侧面火柴棒样植骨及桡骨茎突切除术治疗，取得满意效果，且用1个小切口解决了所有手术治疗，现报告如下。     

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～ 2 0 0 1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 2 0 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Cooney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。     

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。     

钛针固定治疗经舟骨月骨关节骨折脱位1例

患者,男,46 岁,于2020 年3 月17日摔伤致左腕肿痛、活动受限,于当地医院就诊,行手法整复并石膏外固定,复位效果不佳,患肢持续疼痛.2020 年3 月19日于我院骨科门诊就诊,以左腕经舟骨月骨周围骨折脱位、左桡骨远端骨折收入院.行左腕 CT 三维重建(见图1A),明确诊断为左腕经舟骨月骨周围骨折脱位,左桡骨远端...     

经舟骨月骨周围脱位的X线分型和诊断

经舟骨月骨周围脱位的Ｘ线分型和诊断商振德自１９７７年以来，我们收治２１例经舟骨月骨周围脱位的患者，男１８例，女３例。均有明显外伤史，１９例为患者跌倒时，患肢支撑着地所致，２例为腕背部打击伤。４例行切开复位；１７例行手法复位，石膏外固定。在诊断和治疗过...     

带血管蒂桡骨茎突骨瓣移植治疗腕舟骨不稳定骨折15例

腕舟骨不稳定骨折系指舟骨骨折伴有舟月两骨不稳定 ,由舟骨骨折移位或经舟骨月骨周围脱位造成 ,容易发生骨折不愈合 ,近端缺血性坏死。笔者采用切开复位 ,克氏针内固定和带血管蒂桡骨茎突骨瓣移植治疗此类损伤 15例 ,效果良好。1　临床资料本组 15例 ,男 10例 ,女 5例 ;年龄 2 0～ 4 9岁 ,平均 30岁。左侧 6例 ,右侧 9例。伤因 :高处坠落伤 6例 ,跌伤 4例 ,车祸伤 3例 ,机器绞轧伤 2例。类型 :舟骨移位骨折 9例 ;经舟骨月骨周围脱位 :背侧脱位5例 ,掌侧脱位 1例。外伤距手术时间 :5～ 14d ,平均 7d ,15例均为经手法复位失败者。2　治疗方法…     

背侧入路切开复位治疗经舟骨月骨周围背侧脱位

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。     

腕关节镜联合机器人导航技术在经舟骨月骨周围背侧脱位治疗中的应用

目的探讨腕关节镜辅助下复位经舟骨月骨周围背侧脱位, 机器人导航经皮内固定舟骨的临床疗效。方法我科自2019年11月至2021年11月对7例经舟骨月骨周围背侧脱位患者, 采用腕关节镜辅助复位, 机器人导航下经皮空心加压螺钉内固定舟骨, 克氏针经皮内固定月骨三角骨。术后功能位支具固定, 定期摄X线片和腕关节CT观察骨折愈合情况。结果 7例患者均获得随访, 时间为8～20个月, 平均13.5个月。7例患者舟骨均获得愈合, 亦无月骨坏死及舟月、月三角分离发生。采用改良Mayo腕关节评分标准评定:优6例, 良1例。结论腕关节镜联合机器人导航治疗经舟骨月骨周围背侧脱位, 复位精准, 螺钉位置满意, 疗效可靠, 是一个值得推荐的治疗方法。     

Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation

Six cases of dorsal transscaphoid perilunate fracture/dislocations and two cases of palmar transscaphoid lunate fracture/dislocations were treated by open reduction and internal fixation of the scaphoid with a Herbert screw. Supplemental Kirschner wire stabilization of the carpus was also used in the two cases of palmar transscaphoid lunate fracture/dislocation. All patients were male, with an average age of 23.6 years. The follow-up averaged 18.9 months. A clinical evaluation scoring system assessing pain, ability to function in an occupation, range of motion, grip strength, and radiographic appearance of the wrist was used. Based on this system the scoring of the six cases of dorsal transscaphoid perilunate fracture/dislocations that were treated was three excellent, one good, and one fair result, while the scoring of both palmar transscaphoid lunate fracture/dislocations showed poor results.     

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.     

Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases

ABSTRACT: BACKGROUND: Transscaphoid perilunate fracture dislocation is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is not possible and needs extensive dissection. An alternative treatment such as proximal row carpectomy may be required for neglected injuries, but surgical outcome is not as good as that of an early reduction. We aim to present an alternative technique of staged reduction and fixation in patients of neglected transscaphoid perilunate dislocations and study its outcome. Material & Methods 16 cases (14 males & 2 females) with neglected transscaphoid perilunate fracture dislocation (> 3 month old) were treated with staged reduction. Mean duration between injury and surgery was 4.5 months. In first stage an external fixator was applied across the wrist and distraction was done at 1mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation. RESULTS: The mean duration between two surgeries was 2.4 weeks (range 2- 4 weeks). 9 cases had excellent results, 5 had good result. Two patients developed reflex sympathetic dystrophy and had fair results. CONCLUSION: Staged reduction should be considered for neglected transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.     

切开复位内固定治疗经舟骨月骨周围脱位疗效分析

目的 评价手术治疗急性期经舟骨月骨周围背侧脱位的疗效.方法 2004年2月至2008年2月对13例患者在伤后1周内行经舟骨月骨周围背侧脱位切开复位内固定术,男9例,女4例;年龄25～53岁,平均42.3岁.术后按照Mayo腕关节评分、DASH评分评价随访时患者的临床疗效.同时术后拍摄标准腕关节正侧位片,观察舟月角及桡...     

Transscaphoid perilunate dislocation with a dorsal dislocated proximal scaphoid fragment. Report of 2 cases

Two patients with a dorsal transscaphoid perilunate dislocation with a dorsal dislocation of the proximal fragment of the scaphoid are described. Our 2 cases demonstrate that there can be a simultaneous fracture of the scaphoid and rupture of the scapholunate ligaments, which require open reduction and internal fixation.     

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.     

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion.     

Transscaphoid-transtriquetral perilunate fracture dislocation: report of a case and review of the literature

INTRODUCTION: A transscaphoid and transtriquetral perilunate fracture dislocation is fairly rare among the known cases of perilunate fracture dislocations, and the details of the initial treatment and outcome of this injury have never been reported. MATERIALS AND METHODS: A 21-year-old, right-handed man presented with fractures at the proximal third of the scaphoid and at the mid-body of the triquetrum with an associated dorsal perilunate dislocation after a fall onto his outstretched hand. Under general anesthesia, closed reduction was attempted with 3 kg of traction applied by means of finger traps. After anatomical reduction was achieved, percutaneous fixation was applied to both the triquetrum and scaphoid using cannulated screws. A short arm thumb spica splint was applied for 2 weeks, and part-time splinting was continued for an additional 3 weeks. The patient subsequently underwent 3 months of intensive range-of-motion and muscle-strengthening exercises. RESULTS: At the final follow-up examination 68 months after the initial operation, the arc of motion of the right wrist, 150 degrees (extension plus flexion arc), and grip strength, 41 kg, were 94% and 103% of the values for the unaffected wrist, respectively. Radiographs showed a bony union of the scaphoid and triquetrum, and no sign of avascular necrosis in the proximal scaphoid fragment, as well as other carpi. No midcarpal or radiocarpal degenerative arthritis was observed, and the normal carpal bone relationships were still maintained, with a scapholunate angle of 48 degrees and a scapholunate gap of 2 mm. CONCLUSION: We recommend closed reduction and percutaneous screw fixation of the scaphoid, as well as the triquetrum in this case, to minimize the interruption of the blood supply to the carpus and also to obtain rigid fixation during the procedure.     

Luxation ouverte transscaphorétrolunaire du carpe avec avulsion antébrachiale du semi-lunaire et du fragment scaphoïdien

The authors report a case of dorsal transscaphoid perilunate dislocation which is noteworthy because there was significant anterior displacement of the lunate together with the proximal part of the scaphoid. The lunate was propelled in front of the radial epiphysis and the proximal part of the scaphoid ended up in front of the metaphyseal part of the radius. An emergency partial proximal row carpectomy was performed, preserving the distal part of the scaphoid. Good anatomic and functional result was observed at 6 years follow-up.     

DORSAL TRANSSCAPHOID PERILUNATE DISLOCATION THROUGH AN ISOLATED SCAPHOID NON-UNION

An unusal case of a traumatic dorsal transscaphoid perilunate dislocation occurring through an isolated scaphoid non-union is presented. This set of circumstances has not, to the authors' knowledge, been described previously.