Liu Bo, Chen Shan-Lin, Zhu Jin, Wang Zhi-Xin, Shen Jie
Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China ; The fourth Clinical College of Peking University, Beijing, China.
J Wrist Surg. 2015 May;4(2):93-100. doi: 10.1055/s-0035-1550162.
Purpose The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Methods Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture-dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range 6-32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo Wrist Score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire; and Patient-Rated Wrist Evaluation (PRWE) score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. Results The range of flexion-extension motion of the injured wrist averaged 86% of the values for the contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean QuickDASH score was 6, and the mean PRWE score was 10. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in one patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Conclusions Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results.
Level IV, Therapeutic.
目的 本研究旨在评估关节镜辅助下微创复位与内固定治疗月骨周围脱位和骨折脱位的疗效。方法 2012年6月至2014年5月期间，对24例背侧月骨周围脱位或骨折脱位患者采用关节镜辅助复位和经皮内固定治疗。平均随访时间为14.8个月（范围6 - 32个月）。根据活动范围、握力、梅奥腕关节评分、上肢、肩部和手部快速残疾评定量表（QuickDASH）问卷以及患者自评腕关节评估（PRWE）评分评估临床疗效。影像学评估包括舟骨愈合时间、腕骨排列以及是否出现关节炎。结果 受伤腕关节的屈伸活动范围平均为对侧腕关节的86%。受伤腕关节的握力平均为对侧腕关节的83%。QuickDASH评分均值为6分，PRWE评分均值为10分。根据梅奥腕关节评分，13例患者（54%）的总体功能结果评为优秀，6例（25%）为良好，4例（17%）为中等，1例（4%）为差。1例患者出现舟骨不愈合。所有患者术中获得的复位均维持在正常范围内。末次随访时所有患者均未出现关节炎。结论 根据我们的早期随访结果，关节镜辅助下微创复位经皮内固定是治疗月骨周围损伤的一种可靠且良好的替代方法。
四级，治疗性。
