Kuo Christina E, Wolfe Scott W
Hand and Upper Extremity Service, The Hospital for Special Surgery, New York, NY 10021, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):998-1013. doi: 10.1016/j.jhsa.2008.04.027.
Injuries to the scapholunate joint are the most frequent cause of carpal instability and account for a considerable degree of wrist dysfunction, lost time from work, and interference with activities. The complex arrangement and kinematics of the 2 rows of carpal bones allows for an enormous degree of physiologic motion, and a hierarchy of primary and secondary ligaments serves to balance an inherently unstable structure. Although insufficient to cause abnormal carpal posture or collapse on static radiographs, an isolated injury to the scapholunate interosseous ligament may be the harbinger of a relentless progression to abnormal joint mechanics, cartilage wear, and degenerative change. Intervention for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalizing carpal kinematics. In this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate articulation and provide a foundation for understanding the spectrum of scapholunate ligament instability. We propose an algorithm for treatment based on the stage of injury, degree of secondary ligamentous damage, and arthritic change.
舟月关节损伤是腕关节不稳定最常见的原因，会导致相当程度的腕关节功能障碍、误工以及影响日常活动。两排腕骨的复杂排列和运动学特性使得腕关节具有极大程度的生理活动度，一系列主次韧带起到平衡本质上不稳定结构的作用。虽然孤立的舟月骨间韧带损伤不足以在静态X线片上导致腕关节异常姿势或塌陷，但它可能是向异常关节力学、软骨磨损和退变改变持续进展的先兆。针对舟月关节不稳定的干预旨在通过恢复韧带连续性和使腕关节运动学特性正常化来阻止退变进程。在本综述中，我们讨论舟月关节的解剖结构、运动学特性和生物力学特性，并为理解舟月韧带不稳定的范围提供基础。我们提出一种基于损伤阶段、继发韧带损伤程度和关节炎改变的治疗方案。
