合并桡骨远端骨折舟月分离的骨间韧带修补

Internal fixation and scapholunate interosseous ligament repair for distal radius fracture accompanied with scapholunate dissociation

摘要:

［目的］ 探讨内固定与舟月骨间韧带 （scapholunate ligament, SLIL） 修补治疗合并桡骨远端骨折舟月分离 （scapholu- nate dissociation, SLD）的疗效。［方法］回顾性分析 2014 年 6 月—2019 年 12 月采用内固定与 SLIL 修复治疗的新鲜桡骨远端骨折合并 SLD 的 14 例患者的临床资料。评价临床及影像结果。［结果］术中发现，SLIL 部分撕裂 9 例，完全撕裂 5 例，所有患者均顺利完成手术，无血管、神经损伤等严重并发症。所有患者随访（19.12±5.84）个月，末次随访时 VAS 评分较术前显著减少 （P<0.05），改良 Mayo 腕关节评分较术前显著增加（P<0.05）。末次随访时患侧背伸、旋前、旋后、握力与健侧相比差异均无统计学意义（P>0.05），但腕关节屈曲仍显著小于健侧（P<0.05）。术后 8 周，舟月间隙、舟月角均显著改善，恢复到正常范围；掌倾角、桡偏角也显著改善（P<0.05），手术前后尺骨变异的差异无统计学意义（P>0.05）。所有骨折均骨性愈合，SLD 得到纠正。［结论］对于新鲜合并桡骨远端骨折的 SLD，复位固定桡骨的同时修补 SLIL，能够取得良好的临床疗效。

Abstract:

[Objective] To explore the clinical outcomes of internal fixation and scapholunate interosseous ligament (SLIL) repair for distal radius fractures accompanied with scapholunate dissociation (SLD) . [Methods] A retrospective study was performed on 14 patients who underwent internal fixation and SLIL repair for acute distal radius fractures accompanied with SLD in our hospitals from June 2014 to December 2019. The clinical and radiographic consequences were evaluated. [Results] During operation partial rupture of SLIL was found in 9 patients, while complete SLIL tear was noted in 5 patients. All the patients had surgical procedures performed smoothly without serious complications, such as neurovascular injuries. As time went during the follow up lasted for (19.12±5.84) months on an average, the VAS score significantly decreased (P＜0.05) , whereas the Mayo wrist score significantly increased (P＜0.05) . At the latest follow up, there were no significant differences in terms of range of motions (ROMs) in dorsal extension, pronation and supination, as well as grip strength be- tween the affected and unaffected sides (P＞0.05) , despite that the affected side had significantly less palmar flexion than the unaffected side (P＜0.05) . Radiographically, the scapholunate space and angle significantly improved postoperatively compared with those preopera- tively to the normal ranges (P＜0.05) , associated with significant improvement in radial inclination and volar tilt (P＜0.05) , regardless of un- changed ulnar variation (P＞0.05) . All the patients got fracture healed with SLD corrected on imaging at the latest follow up. [Conclusion] The internal fixation and SLIL repair do achieve satisfactory clinical outcomes for acute distal radius fractures accompanied with SLD.