Masquelet A C, Strube F, Nordin J Y
Service de Chirurgie orthopédique et réparatrice, Hôpital Avicenne, Bobigny.
Chirurgie. 1993;119(9):530-4.
Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scaphotrapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.
舟大多角韧带复合体的孤立损伤尚未得到充分认识。该韧带复合体包括粗壮的舟大多角韧带、桡侧腕屈肌腱鞘底部和舟头韧带。1991年8月至1992年5月期间，我们诊断并治疗了4例该韧带复合体的部分慢性创伤后病变。大鱼际肌隆起底部存在慢性疼痛，拇指 - 示指 - 中指捏物时不稳定。标准X线检查结果正常。腕关节造影显示桡侧腕屈肌腱鞘充盈，证实韧带断裂。手术探查发现2例桡侧腕屈肌腱鞘完全断裂，另外2例合并舟大多角韧带完全断裂。所有病例均对韧带结构进行了直接修复。将桡侧腕屈肌腱缝合至舟骨结节以保护并加强韧带修复。对患者进行了6至12个月的随访。所有4例患者中指捏力恢复正常。1例患者工作时仍有慢性疼痛。
