Porter M L, Tillman R M
Park Hospital, Davyhulme.
J Hand Surg Br. 1992 Feb;17(1):63-8. doi: 10.1016/0266-7681(92)90013-r.
22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radioulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2 1/2 years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radioulnar joint were also important.
报告了22例遭受高能腕部损伤的患者。这些复杂损伤导致桡骨远端关节面破坏。相关损伤包括舟月骨分离（18%）、中央冲压伤（14%）、尺骨骨折（41%）和桡尺远侧关节分离（23%）。9例骨折（41%）为开放性骨折，近三分之一的患者有其他骨骼损伤。所有患者均采用外固定治疗，平均随访2.5年后进行复查。结果无优，仅有10例良（45%）。平均功能障碍为32%。外固定器在维持关节外对线方面有效，但在确保关节面准确复位方面无效。关节面残留不平整是不良预后特征。所有5例（22%）关节台阶超过2mm的患者均出现症状性关节炎。未能恢复关节线并不能解释所有不满意的结果；舟月骨持续分离和桡尺远侧关节问题也很重要。
