Mayfield J K, Johnson R P, Kilcoyne R K
J Hand Surg Am. 1980 May;5(3):226-41. doi: 10.1016/s0363-5023(80)80007-4.
The pathomechanics, ligamentous damage, and degree of carpal instability in perilunate and lunate dislocations were analyzed by experimentally loading 32 cadaver wrists to failure. Thirteen perilunate and two lunate dislocations were produced. The mechanism of injury was extension, ulnar deviation, and intercarpal supination. These dislocations occurred in a sequential fashion due to progressive and specific ligamentous disruptions and were classified according to the degree of perilunar instability (PLI). Stage I perilunar instability (scapholunate diastasis) had the least degree of carpal instability. Lunate dislocations (stage IV PLI) had the highest degree of carpal instability. Radial styloid fractures were produced in seven as a result of avulsion. Scaphoid rotation was created in eight and was due to rupture of the radioscaphoid and scapholunate ligaments. Reduction was accomplished by reversing the mechanism of injury--that is, intercarpal pronation, radial deviation, and palmar flexion. Stress roentgenograms employing longitudinal carpal compression in radial and ulnar deviation were helpful in determining the degree of associated carpal instability.
通过对32个尸体手腕进行实验性加载直至破坏，分析了月骨周围脱位和月骨脱位的病理力学、韧带损伤及腕骨不稳定程度。造成了13例月骨周围脱位和2例月骨脱位。损伤机制为伸展、尺侧偏斜和腕骨间旋后。由于渐进性和特定的韧带断裂，这些脱位以连续的方式发生，并根据月骨周围不稳定（PLI）程度进行分类。I期月骨周围不稳定（舟月关节分离）的腕骨不稳定程度最低。月骨脱位（IV期PLI）的腕骨不稳定程度最高。7例因撕脱导致桡骨茎突骨折。8例出现舟骨旋转，是由于桡舟韧带和舟月韧带断裂所致。通过逆转损伤机制进行复位，即腕骨间旋前、桡侧偏斜和掌屈。在桡侧和尺侧偏斜时采用纵向腕骨压缩的应力X线片有助于确定相关腕骨不稳定的程度。
