SCAPHO-LUNATE DISSOCIATION A wrist sprain may be followed by persistent pain and tenderness over the dorsum just distal to Lister’s tubercle. X-rays show an excessively large gap between the scaphoid and the lunate. The scaphoid may appear foreshortened, with a typical cortical ring sign. In the lateral view, the lunate is tilted dorsally and the scaphoid anteriorly (DISI pattern). Treatment Scapho-lunate instability causes weakness of the wrist and recurrent discomfort. If seen early (i.e. less than 4 weeks after injury) the scapho-lunate ligament should be repaired directly with interosseous sutures, protected by K-wires for 6 weeks and a cast for 8–12 weeks. If seen between 4 and 24 weeks, then the ligament is unlikely to heal. Blatt’s capsulodesis is helpful: a proximally based flap of dorsal capsule is attached to the back of the scaphoid to haul it back from flexion into a normal position. In chronic lesions without secondary osteoarthritis, a capsulodesis or ligament reconstruction is attempted. If there is severe symptomatic osteoarthritis then a limited intercarpal arthrodesis or radio-carpal arthrodesis is performed. ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理: dorsum美 /'dɔrsəm/n. 背部 Lister’s tubercle Lister’s 结节 tubercle /ˈtuːbərkl/n. (皮肤、骨头或植物上的)结节,疣粒,小块茎;(肺)结核结节 capsulodesis 关节囊固定术 flap /flæp/n. 拍打,拍打声;神经紧张;(飞机的)襟翼;风门,挡板;[医]皮瓣 haul /hɔːl/vt. (用力)拖,拉 lesion/ˈliːʒn/n. 损害;身体上的伤害;机能障碍 百度翻译: 月骨游离 腕关节扭伤后可能伴有持续性疼痛和背部靠近李斯特结节的压痛。 X光显示舟骨和月骨之间的间隙过大。舟状骨可能出现缩短,典型的皮质环征。从侧面看,月骨向后倾斜,舟骨向前倾斜(DISI模式)。 治疗 肩胛月骨不稳导致手腕无力和反复不适。如果早期(即受伤后不到4周),肩胛骨-月骨韧带应直接用骨间缝线修复,用K形钢丝保护6周,石膏8-12周。如果在4到24周之间看到,那么韧带不太可能愈合。布拉特的囊膜融合术是有帮助的:背囊的近端皮瓣附着在舟状骨的背部,将其从屈曲状态拉回到正常位置。在没有继发性骨关节炎的慢性病变中,可以尝试囊融合术或韧带重建术。如果有严重的症状性骨关节炎,则可进行有限的腕关节间融合术或放射性腕关节融合术。 |
|