Minami Akio, Kato Hiroyuki, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Hand Surg. 2003 Jul;8(1):1-6. doi: 10.1142/s0218810403001443.
We previously reported that our repair and/or reconstruction of the scapholunate interosseous ligament reduced the scapholunate dissociation and improved the clinical results. Re-evaluation of these patients after three years revealed that malrotation of the scaphoid advanced significantly although the clinical results declined only slightly. To prevent progression of scaphoid malrotation, a modified dorsal capsulodesis was subsequently added to the ligamentous repair of scapholunate dissociation. The records of 17 patients were available for this study. The time lapse from injury to surgical treatment ranged from four days to one year and six months. All but three patients were operated less than two months after the injury. All patients were followed for more than one year, with an average of 49 months. Clinical results were expressed by a modification of the point score method of Green and O'Brien. Scapholunate angles were measured on lateral X-ray films with the wrist in neutral position. Overall clinical results averaged 83 points (range: 25-100). The scapholunate angles averaged 49 degrees (range: 45-60). In the three patients, in whom the operation was performed more than 11 months after the injury, the clinical results averaged 38 points and scapholunate angles averaged 54 degrees, respectively. These clinical and X-ray results suggest that early repair of the scapholunate interosseous ligament along with a modified dorsal capsulodesis is a useful procedure in the treatment of scapholunate dissociation.
我们之前报道过，我们对舟月骨间韧带的修复和/或重建减少了舟月骨分离，并改善了临床效果。对这些患者三年后的重新评估显示，虽然临床效果仅略有下降，但舟骨旋转不良明显加重。为防止舟骨旋转不良进展，随后在舟月骨分离的韧带修复中增加了改良背侧关节囊固定术。本研究纳入了17例患者的记录。从受伤到手术治疗的时间间隔为4天至1年6个月。除3例患者外，所有患者均在受伤后不到两个月接受手术。所有患者均随访超过1年，平均随访49个月。临床效果采用Green和O'Brien评分法的改良版进行评估。在腕关节中立位的侧位X线片上测量舟月角。临床效果平均为83分（范围：25 - 100分）。舟月角平均为49度（范围：45 - 60度）。在受伤后11个月以上接受手术的3例患者中，临床效果平均为38分，舟月角平均为54度。这些临床和X线结果表明，早期修复舟月骨间韧带并结合改良背侧关节囊固定术是治疗舟月骨分离的有效方法。
