Ouarab M, Fnini S, Harfaoui A, Trafeh M
Service de chirurgie orthopédique et traumatologique, CHU Ibnou Rochd, Casablanca, Maroc.
Chir Main. 2000 Sep;19(4):235-42. doi: 10.1016/s1297-3203(00)73486-x.
Volar perilunar dislocation of the carpus is rare. We report three cases here. The patients were 18, 23 and 31 years of age. The etiology was a traffic accident in all cases and palmar hyperflexion of the wrist was noted in all three. Palmar dislocation was associated with a scaphoid fracture in two cases. In the third case, there was an associated fracture of the radial styloid and capitate. The patients were operated on after a delay of 48 h in two cases and four weeks in one. The dorsal approach was used in two cases and the palmar approach in the other. Reduction, fracture osteosynthesis and intracarpal temporary arthrodesis were the main lines of treatment. The functional result evaluated after a minimum of eight months' follow-up was good in two cases, and acceptable in one (Green and O'Brien score). Volar perilunar dislocation is often associated with fracture of a carpal bone, mainly the scaphoid. It occurs in young men, after a violent injury. Polytrauma is often associated. Closed reduction is attempted first but open reduction is often needed because of instability of the lesion. The functional result is good if the treatment restores carpal bone congruence.
腕骨月骨掌侧脱位较为罕见。我们在此报告三例。患者年龄分别为18岁、23岁和31岁。病因均为交通事故,且三例患者均存在腕关节掌侧过度屈曲。两例患者的掌侧脱位合并舟骨骨折。第三例患者合并桡骨茎突和头状骨骨折。两例患者在延迟48小时后接受手术,另一例在延迟四周后接受手术。两例采用背侧入路,另一例采用掌侧入路。治疗的主要方法包括复位、骨折内固定和腕骨间临时关节固定。经过至少八个月的随访评估,两例患者的功能结果良好,一例可接受(格林和奥布赖恩评分)。月骨掌侧脱位常合并腕骨骨折,主要是舟骨骨折。其发生于年轻男性,多因暴力损伤所致。常合并多发伤。首先尝试闭合复位,但由于损伤不稳定,往往需要切开复位。如果治疗能恢复腕骨的一致性,则功能结果良好。