Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China.
Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264000, People's Republic of China.
BMC Musculoskelet Disord. 2022 Aug 31;23(1):825. doi: 10.1186/s12891-022-05748-1.
The paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.
Anteroposterial-lateral radiographs of the patient's wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.
Twenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg's perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00-21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75-2.00) and 100.00 (interquartile range, 100.00-100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.
It is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.
本文旨在确认切开复位内固定治疗经舟状骨月骨周围背侧脱位（TSPFD）的长期结果。
对所有病例均采用背侧入路，术前及术后拍摄腕关节正侧位 X 线片。术后常规进行临床和影像学评估。采用掌侧斜角（SLA）、雌激素角（RLA）和月骨三角骨距离（LTD）进行影像学评估。临床评估采用 Krimmer 评分、改良 Mayo 腕关节评分（MWS）、主动屈伸弧（FEA）、桡偏和尺偏弧（RUDA）和握力。疼痛评估采用视觉模拟评分（VAS），评分范围为 0-10。
22 例因腕部外伤接受手术治疗的 TSPFD 患者，回顾性分析手术结果，并进行临床和影像学随访。这些患者的平均年龄为 30 岁。考虑到 Herzberg 的月骨周围背侧骨折脱位分类，19 例为男性，3 例为女性，均为背侧脱位。平均随访时间为 98.3 个月。所有病例均经切开复位内固定获得充分愈合。末次随访时，握力中位数为 20.00（四分位距，20.00-21.25），为健侧的 84.5%。改良 Mayo 腕关节评分评估，12 例为优，10 例为良。末次随访时 VAS 和 Krimmer 评分中位数分别为 1.50（四分位距，0.75-2.00）和 100.00（四分位距，100.00-100.00），均明显优于术前（P < 0.001）。所有患者术前、术后均无神经损伤或针道感染。
早期诊断这种复杂的生物力学损伤并采用切开复位和稳定固定治疗是必要的；适当的治疗有助于获得功能良好和解剖融合的腕关节。
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