Pin P G, Nowak M, Logan S E, Young V L, Gilula L A, Weeks P M
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo 63110.
J Hand Surg Am. 1990 Jan;15(1):110-9. doi: 10.1016/s0363-5023(09)91117-0.
Wrist injuries causing coincident disruptions of the scapholunate and lunotriquetral ligaments commonly result in perilunate dislocations. This article (1) describes our management of eight patients with wrist pain after coincident scapholunate and lunotriquetral ligament disruptions in the absence of perilunate dislocation; and (2) reports the results of biomechanical testing of some of the extrinsic and intrinsic wrist ligament and interprets these data to explain the injury seen clinically. The diagnosis of ligament failure was made on the basis of history, physical examination, arthrography and surgical exploration. Surgical treatment of seven patients consisted of concomitant scapho-trapezio-trapezoid fusion and lunotriquetral fusion. Three of seven patients were free of pain, two had pain only at the extremes of motion, and two required additional surgery. Biomechanical analysis of the scapholunate and lunotriquetral ligaments and two extrinsic wrist ligaments, the radiolunotriquetral and the radioscaphocapitate, confirmed the clinical suspicion that the intrinsic ligaments could be completely disrupted while the extrinsics are only partially injured. Such a scenario could account for the residual stability that prevents the development of perilunate dislocations. Coincident disruption of the scapholunate and lunotriquetral ligaments in the absence of perilunate dislocation is an unusual injury. Treatment with lunotriquetral fusion and scapho-trapezio-trapezoid fusion restored functional use in five of seven wrists while maintaining wrist motion.
导致舟月韧带和月三角韧带同时断裂的腕部损伤通常会导致月骨周围脱位。本文：（1）描述了我们对8例在没有月骨周围脱位的情况下舟月韧带和月三角韧带同时断裂后腕部疼痛患者的治疗方法；（2）报告了一些腕部外在和内在韧带生物力学测试的结果，并对这些数据进行解释以说明临床上所见的损伤情况。韧带损伤的诊断基于病史、体格检查、关节造影和手术探查。7例患者的手术治疗包括同时进行舟状骨-大多角骨-小多角骨融合和月三角融合。7例患者中有3例无痛，2例仅在运动极限时疼痛，2例需要再次手术。对舟月韧带、月三角韧带以及两条腕部外在韧带——桡月三角韧带和桡舟头韧带的生物力学分析证实了临床怀疑，即内在韧带可能完全断裂而外在韧带仅部分损伤。这种情况可以解释为何存在残余稳定性从而防止月骨周围脱位的发生。在没有月骨周围脱位的情况下舟月韧带和月三角韧带同时断裂是一种不常见的损伤。月三角融合和舟状骨-大多角骨-小多角骨融合治疗使7例腕部中的5例恢复了功能使用，同时保持了腕部活动度。
