Bhatia Deepak N
Department of Orthopaedic Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India.
Arthrosc Tech. 2016 Mar 21;5(2):e281-90. doi: 10.1016/j.eats.2015.12.008. eCollection 2016 Apr.
An acute perilunate wrist injury that is unreduced for more than 6 weeks results in severe disability, and even open reduction with stabilization through wide dorsal and volar approaches is technically challenging. This report describes an arthroscopic technique for reduction and percutaneous wire stabilization of a chronic perilunate wrist dislocations. The technique involves initial radiocarpal and midcarpal access through the 6R and 3-4 portals, and these portals are used for synovectomy and debridement of capsular flap tears. The midcarpal joint is accessed initially through the radiocarpal joint, and additional midcarpal portals are used for sequential perilunate adhesiolysis before carpal mobilization and reduction. A percutaneous wire drilled into the lunate is used as a joystick to manipulate the lunate into its anatomic alignment along the carpal bones, and percutaneous transcarpal wire fixation is performed to stabilize the carpus. Arthroscopic and fluoroscopic guidance is used to optimize anatomic reduction and to confirm stability. The wrist is immobilized for 6 weeks; the percutaneous wires are removed thereafter, and the wrist is mobilized. Overall, the arthroscopic technique provides a safe and reproducible method for treatment of this complex chronic injury.
急性月骨周围腕关节损伤若未复位超过6周会导致严重残疾，即便通过广泛的背侧和掌侧入路进行切开复位并固定，在技术上也具有挑战性。本报告描述了一种用于慢性月骨周围腕关节脱位复位及经皮钢丝固定的关节镜技术。该技术首先通过6R和3-4入路进入桡腕关节和腕中关节，这些入路用于滑膜切除和关节囊瓣撕裂的清创。腕中关节最初通过桡腕关节进入，在腕骨活动和复位之前，额外的腕中入路用于依次进行月骨周围粘连松解。钻入月骨的经皮钢丝用作操纵杆，将月骨沿腕骨操纵至其解剖学对线，然后进行经皮跨腕钢丝固定以稳定腕骨。使用关节镜和荧光透视引导来优化解剖复位并确认稳定性。腕关节固定6周；此后取出经皮钢丝，开始活动腕关节。总体而言，关节镜技术为治疗这种复杂的慢性损伤提供了一种安全且可重复的方法。
