Apergis E, Maris J, Theodoratos G, Pavlakis D, Antoniou N
Red Cross Hospital, Athens, Greece.
Acta Orthop Scand Suppl. 1997 Oct;275:55-9.
27 patients (28 cases), were treated for perilunate dislocations in 20 and fracture-dislocations in 8. Capitate displacement was dorsal in 27 cases and palmar in 1 case, and in 16, the scaphoid was fractured. There was no substantial delay of treatment. In 8 patients treated with closed reduction, follow-up averaged 6 (1-15) years. 19 patients (20 cases) who underwent early open reduction with K-wire stabilization and ligamentous repair, had an average follow-up of 2 (0.5-7) years. The clinical outcome was evaluated using a scoring system based on pain, occupation, ROM and grip strength, while the radiographic outcome was assessed according to findings of carpal instability, nonunion of scaphoid, and/or arthrotic changes. In patients treated with closed reduction, results were fair in 3 and poor in 5, while patients treated with early open reduction had a better clinical score with 4 excellent, 9 good, 3 fair and 4 poor results. These findings suggest that perilunate fracture-dislocations are too unstable to be treated with closed reduction. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics.
27例患者（共28例次）接受治疗，其中20例为月骨周围脱位，8例为骨折脱位。头状骨移位方向为背侧者27例、掌侧者1例，16例伴有舟骨骨折。治疗无明显延迟。8例行闭合复位治疗的患者，随访平均6（1 - 15）年。19例（20例次）早期接受切开复位克氏针固定及韧带修复的患者，平均随访2（0.5 - 7）年。临床结局采用基于疼痛、职业、活动度（ROM）和握力的评分系统进行评估，影像学结局根据腕骨不稳、舟骨不愈合和/或关节改变的情况进行评估。接受闭合复位治疗的患者中，结果为一般的3例，差的5例；而早期接受切开复位治疗的患者临床评分较好，优4例、良9例、一般3例、差4例。这些结果表明，月骨周围骨折脱位过于不稳定，不宜采用闭合复位治疗。此外，发现联合治疗方法在背侧月骨周围脱位的处理中有效。最后，切开复位需要修复撕裂的舟月韧带，以获得正常的腕骨运动学。
