Strobel U, Tami I, Andreisek G, Giovanoli P, Calcagni M
Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Switzerland.
Orthopedic Clinic, Ars Medica Clinic, Gravesano-Lugano, Switzerland.
Handchir Mikrochir Plast Chir. 2014 Jun;46(3):169-76. doi: 10.1055/s-0034-1370993. Epub 2014 Apr 23.
The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE).
In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS.
Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results.
MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course.
本研究的目的是通过磁共振成像（MRI）回顾经舟骨月骨周围骨折脱位的结果，以利用MRI的优势来显示创伤后退行性改变、软骨检查、韧带完整性以及腕骨的血管化情况。本研究的第二个目的是将这些发现与功能结果以及个体对手部功能的感知（PRWE）相关联进行解读。
在这项回顾性研究中，对在我们机构接受切开复位内固定治疗的20例患者（1名女性和19名男性）进行了术后平均67（25 - 145）个月的复查。平均年龄为30（12 - 73）岁。通过活动范围（ROM）、握力和捏力来测量功能结果。计算了梅奥和克里默腕关节评分，并进行了SF - 36和患者自评腕关节评估（PRWE）问卷。放射学检查结果包括骨折的愈合情况以及放射学测量指标（改良腕骨高度、舟月间隙、舟月角和桡月角）。使用未注射造影剂的MRI来评估关节的退行性改变、腕骨的血管化情况以及舟月韧带的完整性。使用SPSS计算统计数据。
与未受伤的对侧相比，活动范围和力量降低了10% - 20%。尽管大多数患者（85%）在梅奥和克里默腕关节评分中取得了良好至非常好的结果，但在至少五分之一接受评估的腕骨间关节患者中，MRI显示95%的病例存在骨关节炎。MRI显示5例患者的舟月韧带完全撕裂，2例患者部分撕裂。同一组患者还表现出最严重的退行性改变。然而，患者满意度与影像学结果之间没有相关性。
MRI检查结果以及X线检查结果与经舟骨月骨周围骨折脱位手术治疗后的主观和客观功能结果均无相关性。可以推测，MRI中所见的舟月韧带损伤在长期病程中起主要作用。
