Earp Brandon E, Waters Peter M, Wyzykowski Richard J
Children's Hospital Boston, Boston, MA 02115, USA.
J Bone Joint Surg Am. 2006 Nov;88(11):2448-55. doi: 10.2106/JBJS.D.02778.
Scapholunate ligament injury is rare in the adolescent and pediatric population, and the results of treatment have not been well described. The purpose of the present study was to review the outcomes of arthroscopic management of patients with persistent wrist pain and scapholunate ligament injury as documented on arthroscopic examination who had had a failure of at least six months of nonoperative management.
The medical records of thirty-two pediatric and adolescent patients who underwent arthroscopic treatment of scapholunate ligament injuries were retrospectively reviewed to obtain preoperative and postoperative modified Mayo wrist scores, radiographic data, and intraoperative findings, including the classifications of interosseous ligament injury, chondral injury, and other abnormalities. Patients were contacted after a minimum of two years of follow-up for reevaluation of the Mayo wrist scores.
Arthroscopic evaluation revealed thirty Geissler type-II tears and two Geissler type-III tears. In addition to these scapholunate ligament injuries, seven of the thirty-two patients had partial tears of the short radiolunate ligament that appeared to be at the site of impaction from carpal subluxation, twelve had a triangular fibrocartilage complex injury, and twenty-seven had a chondral injury. The modified Mayo wrist scores showed improvement following arthroscopic débridement of partial-thickness tears and associated chondral injuries. The average wrist score was 66.3 preoperatively and 91.6 at an average of forty-three months of follow-up. Eight patients required subsequent surgery because of deterioration in their clinical status. After a mean duration of follow-up of 30.8 months, the average wrist score was 87.1.
The majority of pediatric and adolescent patients with wrist pain who have a failure of nonoperative management and who have a Geissler type-II scapholunate ligament tear on arthroscopic examination can have substantial long-term improvement following arthroscopic débridement of the tear combined with treatment of other associated injuries.
舟月韧带损伤在青少年和儿童群体中较为罕见，且治疗结果尚未得到充分描述。本研究的目的是回顾经关节镜检查证实存在舟月韧带损伤且至少6个月非手术治疗失败、伴有持续性腕部疼痛的患者接受关节镜治疗的结果。
回顾性分析32例接受舟月韧带损伤关节镜治疗的儿童和青少年患者的病历，以获取术前和术后改良梅奥腕关节评分、影像学数据以及术中发现，包括骨间韧带损伤、软骨损伤和其他异常的分类。在至少随访两年后联系患者，重新评估梅奥腕关节评分。
关节镜评估显示30例Geissler II型撕裂和2例Geissler III型撕裂。除这些舟月韧带损伤外，32例患者中有7例桡月短韧带部分撕裂，似乎位于腕骨半脱位撞击部位；12例有三角纤维软骨复合体损伤；27例有软骨损伤。改良梅奥腕关节评分显示，对部分厚度撕裂及相关软骨损伤进行关节镜清创术后有所改善。术前平均腕关节评分为66.3分，平均随访43个月时为91.6分。8例患者因临床状况恶化需要后续手术。平均随访30.8个月后，平均腕关节评分为87.1分。
大多数非手术治疗失败、关节镜检查显示Geissler II型舟月韧带撕裂的儿童和青少年腕部疼痛患者，在对撕裂进行关节镜清创并治疗其他相关损伤后，可获得显著的长期改善。
