Mrkonjic Ante, Lindau Tommy, Geijer Mats, Tägil Magnus
Department of Hand Surgery, Clinical Sciences, Lund University and Skåne University Hospital, Sweden.
Pulvertaft Hand Centre, Derby, United Kingdom.
J Hand Surg Am. 2015 Jun;40(6):1077-82. doi: 10.1016/j.jhsa.2015.03.017. Epub 2015 Apr 30.
To evaluate the natural history of untreated complete or partial scapholunate (SL) ligament tears associated with displaced distal radius fractures.
Between 1995 and 1997, 51 consecutive patients aged < 60 years with displaced distal radius fractures were examined arthroscopically to assess for concomitant soft tissue injuries. Thirty-two of 51 patients had an SL ligament tear, 10 had a complete tear (Lindau grade 3), and 22 had a partial tear (Lindau grades 1 and 2). Thirty-two patients had AO type-C fractures, 3 had type-B fractures, and 16 had type-A fractures. In 2010, 47 of the 51 patients were still alive, and they were invited for an interview, clinical examination, and radiography.
Thirty-eight of the 51 original patients participated in the long-term follow-up. Mean grip strength was 83% relative to the contralateral hand in patients with a complete tear, as compared with 92% in patients with partial or no SL tears (nonsignificant). Median Disabilities of the Arm, Shoulder, and Hand questionnaire score was 2 (range, 0‒55) for complete SL tears, compared with 9 (range, 0‒70) for the others (nonsignificant). No differences were found regarding visual analog scale pain or wrist motion/forearm rotation. None of the patients developed a static SL dissociation or a SL advanced collapse wrist.
No major differences were found in the subjective, objective, or radiographic outcome after a complete (grade 3) or partial (grade 1 or 2) SL untreated tear associated with displaced distal radius fracture. It should be noted that none of the patients had a grade 4 SL tear, which may have a different outcome.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
评估与桡骨远端骨折移位相关的未治疗的完全或部分舟月（SL）韧带撕裂的自然病程。
1995年至1997年间，对51例年龄<60岁的桡骨远端骨折移位患者进行关节镜检查，以评估是否存在合并软组织损伤。51例患者中32例存在SL韧带撕裂，其中10例为完全撕裂（Lindau 3级），22例为部分撕裂（Lindau 1级和2级）。32例患者为AO C型骨折，3例为B型骨折，16例为A型骨折。2010年，51例患者中有47例仍存活，邀请他们进行访谈、临床检查和影像学检查。
51例原始患者中有38例参与了长期随访。完全撕裂患者的平均握力相对于对侧手为83%，部分或无SL撕裂患者为92%（无统计学意义）。完全SL撕裂患者的手臂、肩部和手部残疾问卷中位数评分为2（范围0-55），其他患者为9（范围0-70）（无统计学意义）。在视觉模拟评分疼痛或腕关节活动/前臂旋转方面未发现差异。所有患者均未出现静态SL分离或SL晚期塌陷性腕关节。
与桡骨远端骨折移位相关的完全（3级）或部分（1级或2级）未治疗的SL撕裂在主观、客观或影像学结果方面未发现重大差异。需要注意的是，所有患者均无4级SL撕裂，其结果可能不同。
研究类型/证据水平：预后性研究II级。
