Özkan Sezai, Kheterpal Arvin, Palmer William E, Chen Neal C
Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, the Netherlands.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Hand Surg Am. 2019 Aug;44(8):641-648. doi: 10.1016/j.jhsa.2019.03.003. Epub 2019 Apr 29.
Current biomechanical data suggest that static scapholunate (SL) ligament dissociation occurs only when there is loss of competence of the extrinsic ligaments either acutely or with attenuation over time. We aimed to identify whether patients with an SL gap greater than 2 mm demonstrated concomitant dorsal radiocarpal ligament (DRC) and dorsal intercarpal ligament (DIC) ligament changes on magnetic resonance imaging (MRI) scans that were identified as having an SL ligament tear.
We included 90 patients who had a posttraumatic MRI scan of the wrist diagnosed with an SL injury. We recorded basic demographics; 2 attending fellowship-trained musculoskeletal radiologists evaluated the integrity of the SL, DRC, and DIC ligaments and graded these as normal, low-grade injury (sprain or partial tear) or full-thickness tear. The association between the integrity of the DRC and DIC ligaments and the presence of a scapholunate gap of 2 mm or greater was analyzed.
A total of 48 patients (53%) had an SL distance of 2 mm or greater on MRI. Of these patients, 28 (58%) had a partial or total tear of the DIC and/or DRC ligament. Compared with patients with an SL interval less than 2 mm, patients with an SL interval 2 mm or greater more often demonstrated DIC signal change (31% vs 12%), DRC signal change (52% vs 14%), or combined or isolated DIC and/or DRC signal change (52% vs 14%).
Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm. These results reinforce that MRI findings of SL ligament tear need to be interpreted in a larger context, perhaps with additional attention to the DIC and DRC appearance upon MRI. In addition, MRI evaluation of dorsal extrinsic ligaments may aid in clinical decision-making for patients with SL injury.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
目前的生物力学数据表明，静态舟月（SL）韧带解离仅在急性或随着时间推移外在韧带功能丧失时才会发生。我们旨在确定磁共振成像（MRI）扫描显示SL间隙大于2mm的患者是否同时存在桡腕背侧韧带（DRC）和腕骨间背侧韧带（DIC）的改变，这些改变被确定为SL韧带撕裂。
我们纳入了90例因腕部创伤后进行MRI扫描而被诊断为SL损伤的患者。我们记录了基本人口统计学数据；2名接受过肌肉骨骼放射学专科培训的主治放射科医生评估了SL、DRC和DIC韧带的完整性，并将其分为正常、低级别损伤（扭伤或部分撕裂）或全层撕裂。分析了DRC和DIC韧带完整性与2mm或更大舟月间隙存在之间的关联。
共有48例患者（53%）在MRI上显示SL间距为2mm或更大。在这些患者中，28例（58%）存在DIC和/或DRC韧带的部分或完全撕裂。与SL间距小于2mm的患者相比，SL间距为2mm或更大的患者更常出现DIC信号改变（31%对12%）、DRC信号改变（52%对14%）或联合或孤立的DIC和/或DRC信号改变（52%对14%）。
与SL间距小于2mm的患者相比，SL间距为2mm或更大的患者中，背侧外在韧带在MRI上更常显示提示急性或慢性损伤的信号改变。这些结果强化了SL韧带撕裂的MRI表现需要在更大背景下解读的观点，或许还需要额外关注MRI上DIC和DRC的表现。此外，对背侧外在韧带的MRI评估可能有助于SL损伤患者的临床决策。
研究类型/证据水平：诊断性IV级。
