Nakamura R, Imaeda T, Tsuge S, Watanabe K
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Japan.
J Hand Surg Br. 1991 May;16(2):156-61. doi: 10.1016/0266-7681(91)90167-m.
To clarify whether or not scapho-lunate ligamentous injury is common in scaphoid non-union with D.I.S.I. deformity and whether ligamentous repair is required to treat scaphoid non-union with D.I.S.I. deformity, roentgenographic, arthrographic and arthroscopic findings were analysed and compared to those of scaphoid non-union without D.I.S.I. deformity. The carpal alignment of scaphoid non-union with D.I.S.I. deformity treated by reduction and anterior wedge grafting without ligamentous repair was also studied. No significant difference in the scapho-lunate gap was present between 26 patients with D.I.S.I. deformity and 20 without. No statistically significant difference was detected in the incidence of arthrographically-proved scapho-lunate ligamentous tears between the two groups. Arthroscopic examination carried out in 22 patients did not detect massive ligamentous injury, and carpal alignment was satisfactory in most patients who underwent anterior wedge grafting. These results show that ligamentous injury rarely causes D.I.S.I. deformity in scaphoid non-union, and anterior wedge grafting alone is sufficient to correct D.I.S.I. deformity in most cases.
为了阐明舟月韧带损伤在伴 DISI 畸形的舟骨不愈合中是否常见，以及治疗伴 DISI 畸形的舟骨不愈合是否需要韧带修复，我们分析了 X 线、关节造影及关节镜检查结果，并与不伴 DISI 畸形的舟骨不愈合结果进行比较。我们还研究了通过复位及前路楔形植骨治疗伴 DISI 畸形的舟骨不愈合且未行韧带修复时的腕关节对线情况。26 例伴 DISI 畸形患者与 20 例不伴该畸形患者之间，舟月间隙无显著差异。两组间关节造影证实的舟月韧带撕裂发生率无统计学显著差异。对 22 例患者进行的关节镜检查未发现严重韧带损伤，且大多数接受前路楔形植骨的患者腕关节对线情况良好。这些结果表明，韧带损伤很少导致舟骨不愈合中的 DISI 畸形，且在大多数情况下，单纯前路楔形植骨足以纠正 DISI 畸形。
