Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Disabil Rehabil. 2020 Mar;42(6):849-856. doi: 10.1080/09638288.2018.1512165. Epub 2018 Nov 19.
Perilunate (fracture) dislocations are rare injuries and diminished functional outcomes are reported. However, Patient Reported Outcomes (PROs) following these injuries are rarely described. The aim of this study was to investigate the long-term impact of perilunate (fracture) dislocations using a range of measures, including pain, function, and quality of life. This cross-sectional study was conducted from January 2016 until March 2016. Eleven patients who had suffered from perilunate (fracture) dislocations between August 1996 and January 2014 were matched on age and gender with 22 healthy controls. Functional outcome included range of motion and grip strength measurements. The Patient Reported Outcomes included: Patient Reported Wrist Evaluation, Disability of Arm, Shoulder and Hand questionnaire, Michigan Hand Questionnaire and the Short Form-36. The 11 patients that were included (9 males) had a median age at injury of 38 years (IQR 33; 54) and median follow up of 97 months (IQR 84-193). Flexion/extension (mean difference -60°, 95% CI -76, -43, < 0.001) and ulnar/radial deviation (mean difference -28°, 95% CI -38, -18, < 0.001) were significantly diminished in patients following perilunate (fracture) dislocations. Grip strength was not affected. The patients experienced significantly more pain as assessed on all pain subscales. Physical functioning was significantly worse in the group with perilunate (fracture) dislocations as assessed on all function subscales, except the PRWE function score and the subscale physical functioning of the Short Form-36. Satisfaction as measured with the Michigan Hand Questionnaire satisfaction subscale (mean difference -36, 95% CI -57, -16, = 0.002) was also reported poorer. No difference was found regarding work participation. A perilunate (fracture) dislocation has a significant impact on everyday life, as patients experience diminished range of motion, pain, diminished physical functioning, diminished satisfaction and report lower general health status than healthy controls. However, no consequences for work participation were found in this study. Level of evidence 3.Implications for rehabilitationFlexion/extension and ulnar/radial deviation remains limited following perilunate (fracture) dislocations.Grip strength is not diminished in patients with perilunate (fracture) dislocations.Pain, restrictions in physical functioning, diminished satisfaction and lower general health status are likely to be present following perilunate (fracture) dislocations.If conservative treatment including pain medication and rehabilitation strategies do not relief pain following perilunate (fracture) dislocations, surgical treatment options such as wrist denervation or arthrodesis should be considered.
舟月（骨折）脱位较为罕见，且据报道其功能预后较差。然而，这些损伤后的患者报告结局（PROs）很少被描述。本研究旨在通过一系列测量，包括疼痛、功能和生活质量，来调查舟月（骨折）脱位的长期影响。这项横断面研究于 2016 年 1 月至 2016 年 3 月进行。11 名患者在 1996 年 8 月至 2014 年 1 月期间遭受舟月（骨折）脱位，与 22 名健康对照者在年龄和性别上相匹配。功能结局包括活动范围和握力测量。患者报告的结局包括：患者报告腕关节评估、上肢功能障碍问卷、密歇根手问卷和简化 36 项健康调查（SF-36）。纳入的 11 名患者（9 名男性）的损伤时中位年龄为 38 岁（IQR 33；54），中位随访时间为 97 个月（IQR 84-193）。舟月（骨折）脱位后患者的屈伸（平均差值-60°，95%CI-76，-43， < 0.001）和尺桡侧偏（平均差值-28°，95%CI-38，-18， < 0.001）明显受限。握力不受影响。所有疼痛子量表评估的疼痛，患者均经历明显更多的疼痛。除 PRWE 功能评分和 SF-36 子量表身体功能外，所有功能子量表评估的舟月（骨折）脱位组的患者身体功能明显更差。密歇根手问卷满意度子量表（平均差值-36，95%CI-57，-16， = 0.002）评估的满意度也较差。工作参与方面未发现差异。舟月（骨折）脱位对日常生活有显著影响，患者的活动范围、疼痛、身体功能、满意度降低，且一般健康状况较健康对照组差。然而，本研究未发现对工作参与的影响。证据等级 3.康复建议舟月（骨折）脱位后，屈伸和尺桡侧偏仍受限。舟月（骨折）脱位患者的握力未降低。舟月（骨折）脱位后，疼痛、身体功能受限、满意度降低和一般健康状况下降可能会存在。如果保守治疗包括疼痛药物治疗和康复策略不能缓解舟月（骨折）脱位后的疼痛，应考虑腕管减压或关节融合等手术治疗选择。
