Koh Kyoung Hwan, Lim Tae Kang, Park Min Jong
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea.
Orthopedics. 2012 Sep;35(9):e1427-30. doi: 10.3928/01477447-20120822-33.
This article describes a case of a 24-year-old man with a total volar extrusion of the lunate and scaphoid proximal pole with concurrent scapholunate dissociation. The viability of the lunate and the proximal pole of the scaphoid are at high risk in this type of injury. Scaphoid nonunion, avascular necrosis of the lunate and proximal pole of the scaphoid, and carpal instability are inevitable unless the blood supply is restored. Thus, proximal row carpectomy at injury may be an acceptable option to avoid these complications and late sequelae, including chronic wrist pain and dysfunction. However, the authors attempted accurate reduction of the extruded bones and internal fixation.Final radiographs and magnetic resonance imaging 12 years postoperatively showed healing without avascular necrosis. Carpal indices involving the scapholunate angle, radiolunate angle, and carpal height ratio were similar in both wrists without evidence of carpal instability or collapse. Range of motion and grip power were 75% and 76%, respectively, compared with those of the uninjured wrist. Clinical scores showed good results, and the patient reported no pain during activities of daily living and was satisfied with his surgical results. Open reduction and internal fixation can be a viable option in this rare pattern of injury.
本文描述了一例24岁男性患者，其月骨和舟骨近端极完全掌侧挤压伤并伴有舟月关节分离。在这种类型的损伤中，月骨和舟骨近端极的存活面临高风险。除非恢复血供，否则舟骨不愈合、月骨及舟骨近端极缺血性坏死以及腕关节不稳将不可避免。因此，受伤时行近排腕骨切除术可能是避免这些并发症和晚期后遗症（包括慢性腕关节疼痛和功能障碍）的可接受选择。然而，作者尝试对挤压出的骨头进行精确复位和内固定。术后12年的最终X线片和磁共振成像显示愈合且无缺血性坏死。涉及舟月角、桡月角和腕骨高度比的腕骨指数在双腕相似，无腕关节不稳或塌陷迹象。与未受伤腕关节相比，活动范围和握力分别为75%和76%。临床评分显示结果良好，患者报告在日常生活活动中无疼痛，对手术结果满意。切开复位内固定对于这种罕见的损伤类型可能是一种可行的选择。
