Massoud Abdel Hakim A, Naam Nash H
Department of Orthopedic Surgery, Al Azhar University, Cairo, Egypt.
J Hand Surg Am. 2012 Sep;37(9):1852-60. doi: 10.1016/j.jhsa.2012.06.009. Epub 2012 Jul 31.
Perilunate injuries are complex and occasionally go unrecognized acutely. Open reduction and internal fixation is a valid treatment option for these injuries. The purpose of this study was to evaluate the functional outcome of treating chronic perilunate injuries with open reduction and internal fixation.
Between 1998 and 2007, we treated 24 patients for chronic perilunate injuries. We excluded 5 patients from this study because they underwent proximal row carpectomy or limited wrist arthrodesis. We treated the remaining 19 patients with open reduction and internal fixation. Mean time from injury to surgery was 29 weeks. All patients were men, with a mean age of 27 years. A total of 13 patients had fracture dislocations (group 1); of these, 11 were transscaphoid and 2 were transscaphoid transcapitate fracture dislocations. Six patients had perilunate dislocations (group 2).
Postoperative follow-up averaged 58 months. All carpal fractures healed at an average of 18 weeks. At final evaluation, the average pain scores during rest, daily activities, and manual work on a 20-point visual analog scale were 0, 2, and 3, respectively, with no significant difference between groups. The active extension and flexion of the wrist averaged 39% and 52% of the uninjured side, respectively. Grip strength averaged 87% of the uninvolved extremity. According to the Mayo wrist scoring system, 58% of all patients (69% of group 1 and 33% of group 2) achieved good to excellent results. A total of 18 patients returned to their original work activities; 14 patients (74%) were very satisfied. No patients required secondary procedures.
Despite late presentation, patients with chronic perilunate injuries can be treated with open reduction internal fixation, with satisfactory results. Patients with lesser arc injuries have less successful outcome. Patients with irreducible dislocations or major articular damage may require wrist salvage procedures.
月骨周围损伤较为复杂，偶尔会在急性期未被识别。切开复位内固定是治疗这些损伤的一种有效方法。本研究的目的是评估切开复位内固定治疗慢性月骨周围损伤的功能结果。
1998年至2007年间，我们治疗了24例慢性月骨周围损伤患者。本研究排除了5例患者，因为他们接受了近排腕骨切除术或有限腕关节融合术。我们对其余19例患者进行了切开复位内固定治疗。受伤至手术的平均时间为29周。所有患者均为男性，平均年龄27岁。共有13例患者发生骨折脱位（第1组）；其中，11例为经舟骨骨折脱位，2例为经舟骨经头状骨骨折脱位。6例患者发生月骨周围脱位（第2组）。
术后平均随访58个月。所有腕骨骨折平均在18周愈合。在最终评估时，在20分视觉模拟量表上，休息、日常活动和体力劳动时的平均疼痛评分分别为0分、2分和3分，两组之间无显著差异。腕关节主动伸展和屈曲平均分别为健侧的39%和52%。握力平均为未受伤肢体的87%。根据梅奥腕关节评分系统，所有患者中有58%（第1组为69%，第2组为33%）获得了良好至优秀的结果。共有18例患者恢复了原来的工作活动；14例患者（74%）非常满意。没有患者需要二次手术。
尽管就诊较晚，但慢性月骨周围损伤患者可通过切开复位内固定治疗，结果令人满意。弧损伤较轻的患者预后较差。不可复位脱位或严重关节损伤的患者可能需要进行腕关节挽救手术。
