DiGiovanni B, Shaffer J
Case Western Reserve University, Cleveland, Ohio, USA.
Am J Orthop (Belle Mead NJ). 1995 Nov;24(11):818-26.
Dorsal perilunate dislocations (PLDs) and dorsal transscaphoid perilunate dislocations (TS-PLDs) are reviewed in this paper, including the diagnosis, initial treatment, and options for definitive treatment. Closed reduction to obtain gross carpal alignment is performed on an urgent basis. Anatomic reduction is essential and is most consistently obtained by open-reduction, percutaneous pin fixation. A dorsal approach alone provides good visualization of the radiocarpal and midcarpal joints and allows efficient stabilization of dislocations and fracture-dislocations. To achieve stable fixation of the carpal bones, the senior author (JS) has developed a surgical technique that employs a specific order and configuration of Kirschner-wire placement. The stabilized joints parallel the major ligaments disrupted in PLD and TS-PLD: the volar radiocapitate, radiotriquetral, and radioscaphoid ligaments. Maintenance of stable anatomic reduction of the radiocarpal and midcarpal joints during healing is the key to satisfactory early and long-term clinical results.
本文对背侧月骨周围脱位（PLD）和经舟骨背侧月骨周围脱位（TS-PLD）进行了综述，包括诊断、初始治疗以及确定性治疗的选择。紧急进行闭合复位以获得腕骨大体对线。解剖复位至关重要，且最常通过切开复位、经皮克氏针固定来实现。单纯的背侧入路能很好地显露桡腕关节和腕中关节，并能有效稳定脱位及骨折脱位。为实现腕骨的稳定固定，资深作者（JS）开发了一种手术技术，该技术采用特定顺序和构型的克氏针置入。稳定后的关节与PLD和TS-PLD中受损的主要韧带平行：掌侧桡头韧带、桡三角韧带和桡舟韧带。愈合过程中维持桡腕关节和腕中关节稳定的解剖复位是获得满意早期和长期临床结果的关键。
