Vichard P, Tropet Y, Balmat P, Brientini J M, Pem R
Service de Traumatologie-Orthopédie, CHU, Hôpital Jean Minjoz, Besançon.
Ann Chir Main Memb Super. 1991;10(4):331-6. doi: 10.1016/s0753-9053(05)80138-3.
Over the past 20 years, 4 cases of ante-lunate carpal dislocation have been treated in the Traumatology and Orthopaedics Department of Besançon. During this same period, 61 cases of retro-lunate dislocation have also been treated. Ante-lunate dislocations are very rare lesions as confirmed by a review of the literature. Our cases do not illustrate the mechanisms of such injuries since 3 cases involved patients with multiple injuries Clinical symptoms may be very minor in children in whom such injuries may easily be overlooked. A thorough interpretation of X-rays is necessary for diagnosis in adults. All 4 cases showed a fracture of the lunate in a frontal plane (factor of instability). Such an instable lesion justifies either internal osteosynthesis or percutaneous trans-articular pinning when rigid internal fixation is impossible. However, in all cases in which the lesion was treated surgically, the capsular plane was not disrupted. Retrospectively, such a finding contraindicates an open surgical approach. Relationships between such dislocations and isolated fractures of the lunate are discussed. The prognosis is mainly determined by early diagnosis and management rather than the type of treatment itself.
在过去20年里，贝桑松创伤与矫形外科共治疗了4例月骨前脱位病例。在同一时期，还治疗了61例月骨后脱位病例。经文献回顾证实，月骨前脱位是非常罕见的损伤。我们的病例并未阐明此类损伤的机制，因为其中3例患者伴有多处损伤。临床症状在儿童中可能非常轻微，此类损伤很容易被忽视。对于成人，彻底解读X线片对于诊断很有必要。所有4例均显示月骨在额状面骨折（不稳定因素）。当无法进行坚固内固定时，这种不稳定损伤可以采用内固定术或经皮关节穿针固定。然而，在所有接受手术治疗的病例中，关节囊平面均未破裂。回顾来看，这一发现不支持采用开放手术入路。文中讨论了此类脱位与月骨孤立性骨折之间的关系。预后主要取决于早期诊断和处理，而非治疗方式本身。
