Chen W S
Department of Orthopedic Surgery, Chang-Gung Memorial Hospital at Kaohsiung, Taiwan.
J Bone Joint Surg Am. 1995 Dec;77(12):1853-7. doi: 10.2106/00004623-199512000-00009.
Ten patients who had median-nerve neuropathy in association with chronic anterior dislocation of the lunate were managed operatively and were followed for an average of five years (range, three to eight years). The average time from the injury to the initial evaluation was twenty-one months (range, six to sixty-five months). All ten patients had pain as well as sensory and motor dysfunction in the distribution on the median nerve. Nerve-conduction-velocity studies revealed a delay in distal motor and sensory latencies in all patients; the distal motor latency averaged 12.5 milliseconds (range 5.6 to 18.6 milliseconds), and the distal sensory latency averaged 12.4 milliseconds (range, 4.8 to 16.8 milliseconds). Three patients had had a failed carpal tunnel release and needed excision of the lunate for decompression of the median nerve. In the other seven patients, three distinctive sites of nerve compression were identified: the volar and dorsal edges of the lunate and the proximal edge of the transverse carpal ligament. Excision of the osseous protuberance (excision of the lunate in three patients and a proximal-row carpectomy in four), combined with a release of the transverse carpal ligament, resulted in relief of the symptoms, functional improvement, and sensory and motor recovery in the distribution of the median nerve.
十名患有月骨慢性前脱位伴正中神经病变的患者接受了手术治疗，并平均随访了五年（范围为三至八年）。从受伤到初次评估的平均时间为二十一个月（范围为六至六十五个月）。所有十名患者在正中神经分布区域均有疼痛以及感觉和运动功能障碍。神经传导速度研究显示，所有患者的远端运动和感觉潜伏期均延迟；远端运动潜伏期平均为12.5毫秒（范围为5.6至18.6毫秒），远端感觉潜伏期平均为12.4毫秒（范围为4.8至16.8毫秒）。三名患者腕管松解术失败，需要切除月骨以减压正中神经。在其他七名患者中，确定了三个不同的神经受压部位：月骨的掌侧和背侧边缘以及腕横韧带的近端边缘。切除骨突起（三名患者切除月骨，四名患者进行近排腕骨切除术），并联合松解腕横韧带，使症状得到缓解，功能得到改善，正中神经分布区域的感觉和运动功能得以恢复。
