Szabo Robert M
University of California, Davis, School of Medicine, Department of Orthopedic Surgery, Davis, CA 95817, USA.
J Hand Surg Am. 2008 Nov;33(9):1645-54. doi: 10.1016/j.jhsa.2008.08.016.
The typical presentation of an acute scapholunate dislocation is swelling, pain, and deformity following acute trauma to the wrist. Radiographs corroborate a gross disturbance of carpal relationships. In a dorsal perilunate dislocation, the lateral radiograph shows the longitudinal axis of the capitate dorsal to the longitudinal axis of the radius and the proximal pole of the scaphoid rotated dorsally. A scapholunate angle of greater than 70 degrees on the lateral view is 1 accepted radiographic criterion for identifying an acute scapholunate dissociation. In the posterior-anterior (PA) projection, the carpus is foreshortened. A scapholunate interval of >2 mm is seen on the PA x-ray (Terry Thomas sign). The lunate is triangular instead of quadrangular in shape. Although closed reduction is possible, maintaining an anatomical reduction is extremely difficult. Therefore, all of these injuries require open reduction and internal fixation and repair of the scapholunate interosseous ligament. Although originally advocated for the treatment of some forms of chronic scapholunate dislocations (>3 months old), dorsal capsulodesis can be useful to reinforce the scapholunate interosseous ligament repair in the subacute setting (>3 weeks old).
急性舟月关节脱位的典型表现是腕部急性创伤后出现肿胀、疼痛和畸形。X线片证实腕骨关系严重紊乱。在背侧月骨周围脱位中，侧位X线片显示头状骨的纵轴位于桡骨纵轴的背侧，舟骨近端向背侧旋转。侧位片上舟月角大于70度是诊断急性舟月关节分离的公认X线标准。在后前位（PA）投照中，腕骨缩短。PA位X线片上可见舟月间隙>2mm（特里·托马斯征）。月骨呈三角形而非四边形。虽然可以进行闭合复位，但维持解剖复位极其困难。因此，所有这些损伤都需要切开复位内固定并修复舟月骨间韧带。虽然背侧关节囊固定术最初是为治疗某些形式的慢性舟月关节脱位（>3个月）而提倡的，但在亚急性情况下（>3周），背侧关节囊固定术有助于加强舟月骨间韧带的修复。
