Savvidou Olga D, Beltsios Michael, Sakellariou Vasileios I, Papagelopoulos Panayiotis J
1st Department of Orthopaedics, Athens University Medical School, ATTIKON University General Hospital, Chaidari, Greece.
Department of Orthopaedics, Thriassio General Hospital, Magoula, Greece.
J Wrist Surg. 2015 May;4(2):76-80. doi: 10.1055/s-0035-1550159.
Background The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) treated with external fixation and Kirschner wires (K-wires). Materials and Methods Twenty patients (18 males and 2 females) with a mean age of 38 years (range 18-59) with an acute PLD or PLFD were treated with external fixator and K-wires. There were 12 PLDs and seven transscaphoid and one transstyloid PLFDs. The median time from trauma to operation was 8 hours (range 2-12 hours). Indirect reduction via ligamentotaxis was achieved in 17 patients with a mean age of 38years (range 18-59). There were 12 PLDs and 5 trans-scaphoid PLFDs; however, in three cases (two transscaphoid and one transstyloid PLFDs), indirect reduction failed and an open reduction was required. The intercarpal ligaments were not repaired even after open reduction. Results The mean follow-up was 39 months (range 18-68 months). The flexion-extension range of motion (ROM) and grip strength of the injured wrist averaged 80% and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's scoring system, overall functional outcomes of the 17 patients were rated as excellent in 4 patients, good in 8, fair in 4, and poor in 1. Fifteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid, and two developed posttraumatic arthritis. Conclusion External fixation plus percutaneous K-wires for the treatment of acute PLDs has satisfactory midterm functional and radiographic outcomes. When successful, this minimally invasive technique is simple and provides restoration of the carpal alignment. It may especially be useful in the polytrauma patient, thanks to its decreased operative time and diminished blood loss, when other emergent surgical procedures may be necessary. An open reduction with possible fixation may be necessary for PLDs and PLFDs, especially in the presence of polytrauma and scaphoid comminution.
IV.
背景 本研究旨在回顾经外固定和克氏针（K 针）治疗的月骨周围脱位（PLD）和骨折脱位（PLFD）的临床及影像学结果。材料与方法 20 例急性 PLD 或 PLFD 患者（18 例男性，2 例女性），平均年龄 38 岁（18 - 59 岁），接受了外固定器和 K 针治疗。其中有 12 例 PLD，7 例经舟骨和 1 例经茎突 PLFD。从受伤到手术的中位时间为 8 小时（2 - 12 小时）。17 例平均年龄 38 岁（18 - 59 岁）的患者通过韧带整复法实现了间接复位。其中有 12 例 PLD 和 5 例经舟骨 PLFD；然而，在 3 例（2 例经舟骨和 1 例经茎突 PLFD）中，间接复位失败，需要切开复位。即使在切开复位后，腕骨间韧带也未修复。结果 平均随访 39 个月（18 - 68 个月）。受伤手腕的屈伸活动范围（ROM）和握力分别平均为对侧手腕相应值的 80%和 88%。根据 Cooney 评分系统，17 例患者的总体功能结果为 4 例优秀，8 例良好，4 例一般，1 例差。15 例患者恢复了以前的职业。2 例经舟骨月骨周围损伤患者出现舟骨不愈合，2 例出现创伤后关节炎。结论 外固定加经皮 K 针治疗急性 PLD 具有令人满意的中期功能和影像学结果。成功时，这种微创技术简单且能恢复腕骨对线。由于其手术时间缩短和失血减少，当可能需要进行其他紧急手术时，它对多发伤患者可能特别有用。对于 PLD 和 PLFD，尤其是在存在多发伤和舟骨粉碎的情况下，可能需要切开复位并可能进行固定。
IV。
