Watson H K, Weinzweig J, Zeppieri J
Connecticut Combined Hand Service, Hartford Hospital, USA.
Hand Clin. 1997 Feb;13(1):39-49.
Wrist injury or repeated wrist sprains probably result in injury to the scapholunate ligament more commonly than previously recognized, which may allow abnormal scaphoid skid under load. This results in a common clinical entity termed DWS. Scaphoid instability is a spectrum condition ranging from minor, asymptomatic findings (seen in 20% of normal adults) through symptomatic findings in patients with normal radiographs to abnormal instability on radiographs, to degenerative change, and, ultimately, to SLAC wrist (see Fig. 1). Appropriate diagnosis and management of each of these wrist disorders are highly dependent upon a keen understanding of normal periscaphoid anatomy as well as the anatomic derangements that occur within the wrist that predispose a given patient to subsequent degenerative changes. With that understanding, the appropriateness of conservative therapy, SL exploration and arthroplasty, ligament repair, triscaphe arthrodesis, or SLAC reconstruction can be readily determined in each case.
手腕损伤或反复的手腕扭伤可能比之前认为的更常导致舟月韧带损伤，这可能会使舟骨在负荷下出现异常滑动。这会导致一种常见的临床病症，称为动态腕舟骨不稳定（DWS）。舟骨不稳定是一种范围广泛的病症，从轻微的、无症状的表现（见于20%的正常成年人）到X线片正常的有症状患者，再到X线片上的异常不稳定、退变改变，最终发展为舟月关节塌陷性骨关节炎（SLAC腕，见图1）。对这些手腕疾病中的每一种进行恰当的诊断和治疗，高度依赖于对舟骨周围正常解剖结构以及手腕内发生的解剖紊乱的敏锐理解，这些解剖紊乱会使特定患者易于出现后续的退变改变。有了这种理解，在每种情况下都可以很容易地确定保守治疗、舟月关节探查及关节成形术、韧带修复、三关节融合术或SLAC重建的适用性。
