Herzberg Guillaume, Burnier Marion, Marc Antoine, Merlini Lorenzo, Izem Yadar
Pavillon T Wrist Surgery Unit, Herriot Hospital, Lyon, France.
J Wrist Surg. 2015 May;4(2):101-9. doi: 10.1055/s-0035-1550344.
Background Open reduction with internal fixation (ORIF) is currently the gold standard treatment of acute perilunate injuries (PLIs). Less invasive surgery, including arthroscopic techniques, has recently emerged in the hope that results similar to those of ORIF could be obtained with less tissue disturbance. Our purpose was to review retrospectively a series of selected PLIs treated with arthroscopic assistance over the past 10 years. Materials and Methods Between 2004 and 2014, a total of 135 acute PLIs were surgically treated in our unit. A total of 27 patients were treated with arthroscopic assistance, among whom 18 were reviewed clinically and radiologically. Description of Technique After an initial closed gross reduction, radio- and midcarpal arthroscopy were performed to clean up the debris and assess the cartilaginous, bony, and ligamentous damage. In 22 cases arthroscopy was followed by either radiolunate and lunotriquetral pinning, scapholunate ligament repair, and SL joint pinning or ORIF of a scaphoid fracture through a mini-invasive dorsal approach. In the remaining six cases, fixation of the ligamentous and/or bony injuries was done using arthroscopy alone. Results Arthroscopic findings are presented as well as the clinical results in a subgroup of patients. At final follow-up, visual analog scale (VAS) pain was rated 18/100 on average (minimum 0, maximum 50). If we consider only the patients without reflex sympathetic dystrophy (RSD; n = 14), the average active wrist flexion-extension was 87° (58% of the normal contralateral side) and the average grip strength was 30 kg (71% of the normal contralateral side). Conclusions Although no statistical comparisons were made, we found that the results were similar to those of ORIF. The results of our study suggest that the use of arthroscopy to treat selected PLIs may be a reliable adjunct either alone or in combination with a dorsal mini-open approach.
背景 切开复位内固定术（ORIF）目前是急性月骨周围损伤（PLI）的金标准治疗方法。包括关节镜技术在内的微创手术最近出现，希望能在减少组织干扰的情况下获得与ORIF相似的结果。我们的目的是回顾性分析过去10年中一系列采用关节镜辅助治疗的特定PLI病例。材料与方法 2004年至2014年期间，我们科室共对135例急性PLI进行了手术治疗。其中27例采用关节镜辅助治疗，对其中18例进行了临床和影像学复查。技术描述 在初步闭合复位后，进行桡腕关节和腕中关节镜检查，以清理碎片并评估软骨、骨和韧带损伤情况。22例患者在关节镜检查后，采用桡月关节和月三角关节克氏针固定、舟月韧带修复及舟月关节克氏针固定，或通过微创背侧入路对舟骨骨折进行切开复位内固定。其余6例患者仅通过关节镜完成韧带和/或骨损伤的固定。结果 呈现了关节镜检查结果以及部分患者的临床结果。在末次随访时，视觉模拟评分（VAS）疼痛平均评分为18/100（最低0分，最高50分）。如果仅考虑无反射性交感神经营养不良（RSD；n = 14）的患者，平均主动腕关节屈伸活动度为87°（对侧正常侧的58%），平均握力为30 kg（对侧正常侧的71%）。结论 尽管未进行统计学比较，但我们发现结果与切开复位内固定术相似。我们的研究结果表明运用关节镜治疗特定的月骨周围损伤单独使用或与背侧小切口入路联合使用可能是一种可靠的辅助治疗方法。
