Meng Hua, Yan Jia-Zhi, Wang Bing, Ma Zong-Bo, Kang Wei-Bo, Liu Bao-Ge
Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
World J Clin Cases. 2021 Aug 26;9(24):7022-7031. doi: 10.12998/wjcc.v9.i24.7022.
Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice.
To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.
This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year.
Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) ( ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group ( = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group ( < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group ( < 0.001).
Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.
伴有月骨窝掌侧边缘（VMLF）损伤的桡骨远端骨折在临床实践中常被忽视或复位不充分。
探讨桡骨远端骨折中VMLF骨折块对腕关节稳定性和功能的影响。
这是一项对2013年1月至2017年12月间接受手术治疗的桡骨远端骨折患者的回顾性研究。根据VMLF骨折块是否固定将患者分为两组。在术前、术后即刻、术后1、3和6个月进行X线和计算机断层扫描，测量舟月角、桡月角、头月角和有效桡月屈曲（ERLF）。在1年时测定梅奥腕关节评分和上肢、肩部和手部功能障碍（DASH）评分。
纳入35例患者。男性15例，女性20例。平均年龄为52.5±14.3（范围：19 - 70）岁。共38个腕关节（左侧17个，右侧15个，双侧3个；固定组16个，未固定组22个）。受伤至手术的间隔时间为1小时至1个月。未固定组术后腕关节不稳定的发生率（86.4%）高于固定组（25.0%）（P≤0.001）。未固定组有10例患者ERLF>25°，固定组无（P = 0.019）。固定组梅奥腕关节评分为94±5.7，未固定组为68±15.1（P<0.001）。固定组DASH评分为4.6±2.5，未固定组为28.5±19.5（P<0.001）。
VMLF损伤，即使是小骨折，也可能损伤桡月韧带，导致术后腕关节不稳定、矢状力线失衡及腕关节功能恢复不佳。
