Finsen Vilhjalmur, Rajabi Benjamin, Rod Oyvind, Roed Kristian, Alm-Paulsen Paal Sandoe, Russwurm Harald
Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway ; Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
J Wrist Surg. 2014 May;3(2):123-7. doi: 10.1055/s-0034-1372514.
Background An increased scapholunate gap is sometimes seen in patients with a distal radial fracture. The question remains as to whether this represents a scapholunate ligament injury that requires treatment. Questions/purposes We wished to examine the natural history of an increased scapholunate gap in patients following an extra-articular distal radial fracture. Patients and Methods We reviewed 260 patients who had sustained a distal radial fracture at a mean of 6.2 (2.7-11.9) years previously and identified 12 extra-articular fractures with an increased gap between the lunate and scaphoid. The mean scapholunate gap was 2.6 (2.1-3.4) mm, and the mean scapholunate angle 62° (39°-90°). Controls were found among the remaining patients with extra-articular fractures. Selection criteria were same sex, age at fracture within 5 years, time between injury and review within 2 years, ulnar variance within 2 mm, and dorsal angulation within 5° of index patient. When more than one control fulfilled the criteria for an index patient, their values were averaged. In total there were 54 controls for the 12 index patients. Results The mean difference between index patients and controls in wrist range of motion was 4%, in grip strength 5%, in visual analog scale (VAS) for pain 1 (on a scale from 1 to 100), in Quick-DASH (Disability of the Arm, Shoulder, and Hand) score 5, and in PRWE score 1. The study was calculated to have the power to detect a difference in Quick-DASH scores and in Patient-Rated Wrist Evaluation (PRWE) scores of 14. Conclusions We conclude that at a mean follow up of 6.2 years following an extra-articular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1-3.4 mm. Level of Evidence III, Case control study.
桡骨远端骨折患者有时会出现舟月间隙增大。问题在于这是否代表需要治疗的舟月韧带损伤。问题/目的：我们希望研究关节外桡骨远端骨折患者舟月间隙增大的自然病程。患者与方法：我们回顾了平均在6.2（2.7 - 11.9）年前发生桡骨远端骨折的260例患者，确定了12例关节外骨折且舟月间隙增大的患者。舟月间隙平均为2.6（2.1 - 3.4）mm，舟月角平均为62°（39° - 90°）。在其余关节外骨折患者中选取对照。选择标准为性别相同、骨折时年龄相差5岁以内、受伤至复查时间在2年以内、尺骨变异在2 mm以内、背侧成角与索引患者相差5°以内。当有多个对照符合索引患者标准时，取其值的平均值。12例索引患者共有54例对照。结果：索引患者与对照在腕关节活动范围上的平均差异为4%，握力差异为5%，疼痛视觉模拟评分（VAS，范围1至100）差异为1，上肢、肩部和手部功能障碍（Quick - DASH）评分差异为5，患者腕关节评价（PRWE）评分差异为1。该研究计算得出有能力检测出Quick - DASH评分和患者腕关节评价（PRWE）评分相差14时的差异。结论：我们得出结论，在关节外桡骨远端骨折平均随访6.2年时，舟月间隙在2.1 - 3.4 mm之间通常无需手术治疗。证据级别：III，病例对照研究。
