经舟骨月骨周围脱位13例分析.doc
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经舟骨月骨周围脱位13例分析
陈德金 赖圣好 张笑峰
[摘要] 目的 探讨经舟骨月骨周围脱位的诊断和治疗。方法 回顾性分析13例经舟骨月骨周围脱位病例，背侧型12例，掌侧型1例；其中7例系新鲜损伤，余6例为陈旧性病例；4例伴正中神经损伤，其中3例见于陈旧性组。新鲜损伤组6例手法闭合复位成功，仅1例因舟骨对位不良接受手术治疗；陈旧性组均接受手术，4例行开放复位内固定，1例行近排腕骨切除术，另1例行桡腕关节融合术。结果 随访的12例中11例(91.67%)获得满意疗效，陈旧性组1例造成舟骨远端缺血性骨坏死，3例遗留正中神经损害症状。结论 经舟骨月骨周围脱位的早期治疗简单且疗效较好，而一旦误诊，则多数需手术治疗，且残留不同程度的功能障碍。提高对本病损伤机制、腕部体征和影像学特点的认识和了解，减少误诊，是提高预后的关键因素之一。
[关键词] 经舟骨月骨周围脱位 治疗，复位 近排腕骨切除术 腕关节融合术 预后
Analyses of 13 cases with trans-scaphoid perilunar dislocation. *CHEN Dejin，LAI Shenghao, ZHANG Xiaofeng *Department of Orthopaedics, Center Hospital of Yayang, Taishun county. Taishun 325506
[Abstract] Objective To analyze the diagnosis and treatment of trans-scaphoid perilunar dislocation (TSPD). Methods Between 1994 and 2000, 13 TSPD of the carpus had been treated. One case was a palmar TSPD and 12 were dorsal TSPD. Early reduction by closed manipulation was done successfully in 6 cases of 7 fresh injury, only one obtained open reduction and internal fixation for inaccurate reduction of the scaphoid fracture. Open reduction and internal fixation (4 cases), proximal row carpectomy (1 case) and arthrodesis of the wrist (1 case) were indicated in 6 cases of old injury. Results 12 of 13 patients were followed up for 8 months to 4 years (average followed up time 25 months). The evaluation of the results by the Cooney WP clinical scale criteria revealed good and excellent in 11 cases (91.67%), one case of distal avascular necrosis of scaphoid and 3 cases of median nerve injury were retained in old TSPD. Conclusion The early treatment of TSPD is simple and has ideal prognosis, which is different from old TSPD. It is very important to comprehend the mechanism producing a TSPD, signs of wrist and the roentgenographic features of TSPD.
[Key wards] trans-scaphoid perilunar dislocation, reduction, proximal row carpectomy, arthrodesis
经舟骨月骨周围脱位(trans-scaphoid perilunar dislocation，TSPD)较少见，仅占所有腕骨骨折脱位的3%。由于腕部复杂的解剖结构，在X线片上的不易辨认性，使之误诊误治率较高，造成病人难以弥补的腕部畸形和功能障碍，成为手外科的棘手问题。本文就我们自1994年至2000年所诊治的13例病例，进行讨论。
临 床 资 料
1.一般资料：本组13例，男11例，女2例；年龄18~51岁，平均33岁。7例新鲜的经舟骨月骨周围脱位病程为伤后1小时~2天，平均8小时；6例陈旧性病例病程为2周~3月，平均6周。脱位类型仅1例为新鲜掌侧型，系坠落过程中腕背受碰撞所致；余12例均为背侧型，摔倒或坠落时手掌撑地8例，机器绞伤3例，另1例系重物砸压。6例陈旧性病例来我院时已误诊，概因对本病认识不足而被误诊为单纯舟状骨骨折(3例)、月骨脱位(1例)和软组织挫伤(2例)。全部病例中有5例伴同侧上肢其它骨折或软组织撕脱伤，且4例伴有正中神经卡压症状，其中3例见于陈旧性病例。
2.治疗方法：7例新鲜的TSPD确诊后即采用闭合手法复位 ......
经舟骨月骨周围脱位13例分析
陈德金 赖圣好 张笑峰
[摘要] 目的 探讨经舟骨月骨周围脱位的诊断和治疗。方法 回顾性分析13例经舟骨月骨周围脱位病例，背侧型12例，掌侧型1例；其中7例系新鲜损伤，余6例为陈旧性病例；4例伴正中神经损伤，其中3例见于陈旧性组。新鲜损伤组6例手法闭合复位成功，仅1例因舟骨对位不良接受手术治疗；陈旧性组均接受手术，4例行开放复位内固定，1例行近排腕骨切除术，另1例行桡腕关节融合术。结果 随访的12例中11例(91.67%)获得满意疗效，陈旧性组1例造成舟骨远端缺血性骨坏死，3例遗留正中神经损害症状。结论 经舟骨月骨周围脱位的早期治疗简单且疗效较好，而一旦误诊，则多数需手术治疗，且残留不同程度的功能障碍。提高对本病损伤机制、腕部体征和影像学特点的认识和了解，减少误诊，是提高预后的关键因素之一。
[关键词] 经舟骨月骨周围脱位 治疗，复位 近排腕骨切除术 腕关节融合术 预后
Analyses of 13 cases with trans-scaphoid perilunar dislocation. *CHEN Dejin，LAI Shenghao, ZHANG Xiaofeng *Department of Orthopaedics, Center Hospital of Yayang, Taishun county. Taishun 325506
[Abstract] Objective To analyze the diagnosis and treatment of trans-scaphoid perilunar dislocation (TSPD). Methods Between 1994 and 2000, 13 TSPD of the carpus had been treated. One case was a palmar TSPD and 12 were dorsal TSPD. Early reduction by closed manipulation was done successfully in 6 cases of 7 fresh injury, only one obtained open reduction and internal fixation for inaccurate reduction of the scaphoid fracture. Open reduction and internal fixation (4 cases), proximal row carpectomy (1 case) and arthrodesis of the wrist (1 case) were indicated in 6 cases of old injury. Results 12 of 13 patients were followed up for 8 months to 4 years (average followed up time 25 months). The evaluation of the results by the Cooney WP clinical scale criteria revealed good and excellent in 11 cases (91.67%), one case of distal avascular necrosis of scaphoid and 3 cases of median nerve injury were retained in old TSPD. Conclusion The early treatment of TSPD is simple and has ideal prognosis, which is different from old TSPD. It is very important to comprehend the mechanism producing a TSPD, signs of wrist and the roentgenographic features of TSPD.
[Key wards] trans-scaphoid perilunar dislocation, reduction, proximal row carpectomy, arthrodesis
经舟骨月骨周围脱位(trans-scaphoid perilunar dislocation，TSPD)较少见，仅占所有腕骨骨折脱位的3%。由于腕部复杂的解剖结构，在X线片上的不易辨认性，使之误诊误治率较高，造成病人难以弥补的腕部畸形和功能障碍，成为手外科的棘手问题。本文就我们自1994年至2000年所诊治的13例病例，进行讨论。
临 床 资 料
1.一般资料：本组13例，男11例，女2例；年龄18~51岁，平均33岁。7例新鲜的经舟骨月骨周围脱位病程为伤后1小时~2天，平均8小时；6例陈旧性病例病程为2周~3月，平均6周。脱位类型仅1例为新鲜掌侧型，系坠落过程中腕背受碰撞所致；余12例均为背侧型，摔倒或坠落时手掌撑地8例，机器绞伤3例，另1例系重物砸压。6例陈旧性病例来我院时已误诊，概因对本病认识不足而被误诊为单纯舟状骨骨折(3例)、月骨脱位(1例)和软组织挫伤(2例)。全部病例中有5例伴同侧上肢其它骨折或软组织撕脱伤，且4例伴有正中神经卡压症状，其中3例见于陈旧性病例。
2.治疗方法：7例新鲜的TSPD确诊后即采用闭合手法复位 ......
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