Department of Orthopaedics and Traumatology, Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.
Clinic of Orthopaedics and Traumatology, VM Medical Park Pendik Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2021 Jan;55(1):57-61. doi: 10.5152/j.aott.2021.19246.
This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with open reduction and internal fixation (ORIF).
Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostly performed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores, and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL) angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzberg classification.
In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range: 20-58); the mean follow-up was 45 months (range: 16-96). Most of the injuries were fracture-dislocations (n=20; 71.4%). According to Mayfield staging, 7 wrists were grade 3, and 20 wrists were grade 4. According to Herzberg staging, 11 (40.7%) patients were stage 2a. The mean VAS was 2.3 (range: 0-5) at rest and 3.3 (range: 0-7) during activity. The mean wrist flexion and extension were 50° (range: 21-80°; 73.5% of the unaffected side) and 45.1° (range: 20-74°; 70.9% of the unaffected side), respectively. The mean radial and ulnar deviation were 14.6° (range: 6-25°; 63.6% of the unaffected side) and 22.3° (range: 5-40°; 64.7% of the unaffected side), respectively. Grip and pinch strength were 57.6 kg (range: 15-106; 65.5% of the unaffected side) and 18.6 kg (range: 8-28; 78.2% of the unaffected side), respectively. The mean Mayo score was 63.3 (range: 20-90), and the DASH score was 24.1±25.2. The mean SL angle was 61.6° (range: 40-83). There was 1 wrist with a pathological SL interval, 11 wrists with dorsal intercalated segmental instability, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range.
In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-term follow-up.
Level IV, Therapeutic Study.
本研究旨在介绍经切开复位内固定（ORIF）治疗舟月周围损伤患者的中期临床和影像学结果。
回顾性分析了 2004 年至 2015 年因舟月周围损伤而行 ORIF 的患者。手术主要采用标准背侧入路。根据 Mayfield 分期对每个损伤进行分级。末次随访时，采用 10cm 视觉模拟评分（VAS）评估疼痛强度。测量腕关节和肘关节活动度、手握力和捏力、改良 Mayo 腕关节评分（Modified Mayo Wrist Scores，MMWS）以及上肢残疾问卷（disabilities of the arm, shoulder, and hand，DASH）评分。在普通 X 线片上评估舟月间隙（scapholunate，SL）角、SL 间隔、腕骨高度和 Gilula 弧的连续性。还使用 Herzberg 分类法评估关节炎的存在。
共纳入符合纳入标准的 26 例男性患者（27 腕）。平均年龄为 40 岁（范围：20-58 岁）；平均随访时间为 45 个月（范围：16-96 个月）。大多数损伤为骨折脱位（n=20；71.4%）。根据 Mayfield 分期，3 例为 3 级，20 例为 4 级。根据 Herzberg 分期，11 例（40.7%）为 2a 期。静息时 VAS 平均为 2.3（范围：0-5），活动时为 3.3（范围：0-7）。平均腕关节屈曲和伸展度分别为 50°（范围：21-80°；未受影响侧的 73.5%）和 45.1°（范围：20-74°；未受影响侧的 70.9%）。平均桡侧和尺侧偏斜分别为 14.6°（范围：6-25°；未受影响侧的 63.6%）和 22.3°（范围：5-40°；未受影响侧的 64.7%）。握力和捏力分别为 57.6kg（范围：15-106；未受影响侧的 65.5%）和 18.6kg（范围：8-28；未受影响侧的 78.2%）。平均 Mayo 评分为 63.3（范围：20-90），DASH 评分为 24.1±25.2。平均 SL 角为 61.6°（范围：40-83）。有 1 例腕关节 SL 间隔病理性增大，11 例存在背侧间插性节段不稳定，3 例存在 Gilula 弧骨折。腕骨高度均在正常范围内。
在舟月周围损伤的治疗中，切开复位内固定可获得中期满意的临床和影像学结果。
IV 级，治疗性研究。
