Tang Chun-Hui, Yao Gao-Wen, Wang Lin, Luo Wei
Department of Orthopaedics, the First People's Hospital of Neijiang City, Neijiang 641000, Sichuan, China;
Department of Orthopaedics, the First People's Hospital of Neijiang City, Neijiang 641000, Sichuan, China.
Zhongguo Gu Shang. 2018 Sep 25;31(9):863-866. doi: 10.3969/j.issn.1003-0034.2018.09.016.
To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy.
From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed.
All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair.
The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.
评估切开复位后联合缝线锚钉修复腕骨间韧带治疗月骨周围损伤的内固定与外固定的可行性，并探讨其手术技巧及治疗效果。
2012年9月至2016年9月，对11例月骨周围损伤患者采用腕骨间克氏针、3.0 mm空心螺钉治疗舟骨骨折、可吸收锚钉修复腕骨间韧带，并结合腕骨间关节固定器进行手术治疗，其中月骨周围脱位6例，经舟骨骨折脱位5例。男7例，女4例，平均年龄43.6岁，年龄范围29～68岁。观察舟月角、桡月角、腕骨高度指数及腕关节活动度。
所有伤口均Ⅰ期愈合。所有患者均随访12～24个月。腕骨高度维持良好，舟月角平均为51°（35°至65°），桡月角平均为7°（-10°至15°），腕骨高度指数平均为0.51（0.50至0.53），5例舟骨骨折患者获得骨愈合。未观察到月骨和舟骨坏死。腕关节活动度平均约为91.5°。握力恢复，相当于对侧的78.5%。其中，6例无疼痛感觉，3例轻度疼痛，2例中度疼痛。根据Cooney腕关节评分，优8例，良2例，可1例。
通过切开复位后联合缝线锚钉修复腕骨间韧带治疗月骨周围损伤，早期进行内固定与外固定干预可获得满意的腕关节功能。该方法具有手术时间短、创伤小、出血少等优点。因此，该技术安全可行，临床效果满意。
