Nagano J, Tada K, Masatomi T, Horibe S
Department of Orthopedic Surgery, Kagawa Medical School, Japan.
Arch Orthop Trauma Surg. 1989;108(4):210-7. doi: 10.1007/BF00936203.
A radiographical screening study of 338 leprotic patients was performed. Clinically, according to a nerve score (NS) designed by us, 12.9% of 674 hands showed mild nerve palsy (NS 5 or 6), 75.9% moderate (NS 3 or 4), and 11.4% severe (NS less than 2). Twenty-nine hands of 26 patients (NS 4.2 on average) demonstrated abnormal changes of the wrist joint on radiographs. We classified them into four groups: (a) lunate collapse (four patients), (b) scaphoid nonunion (eight), (c) scaphoid cyst (three), and (d) trapezium OA (11). In the lunate collapse and the scaphoid nonunion groups, destructive and reconstructive changes as described by Eichenholtz were identified on plain film. These groups demonstrated remarkable instability of the stress and dynamic roentgenograms. In contrast, the scaphoid cyst and trapezium OA wrists showed neither fracture nor instability and fewer changes than the other two groups. We considered the destructive changes that had taken place in the lunate collapse and the scaphoid nonunion wrists to be neuroarthropathy due to long-standing nerve palsy.
对338例麻风病患者进行了影像学筛查研究。临床上，根据我们设计的神经评分（NS），674只手中12.9%表现为轻度神经麻痹（NS为5或6），75.9%为中度（NS为3或4），11.4%为重度（NS小于2）。26例患者的29只手（平均NS为4.2）在X线片上显示腕关节有异常改变。我们将其分为四组：（a）月骨塌陷（4例患者），（b）舟骨不愈合（8例），（c）舟骨囊肿（3例），以及（d）大多角骨骨关节炎（11例）。在月骨塌陷组和舟骨不愈合组中，在平片上可识别出Eichenholtz所描述的破坏性和重建性改变。这些组在应力位和动态X线片上显示出明显的不稳定。相比之下，舟骨囊肿和大多角骨骨关节炎的腕关节既无骨折也无不稳定，且改变比其他两组少。我们认为月骨塌陷和舟骨不愈合腕关节发生的破坏性改变是由于长期神经麻痹导致的神经性关节病。
