주상골 경유 월상골 주위 골절 탈구: 배측 접근법을 통한 주상골 나사못 고정 및 월상-삼각 골간 인대 봉합술 = Trans-scaphoid Perilunate Fracture Dislocations: Screw Fixation of the Scaphoid and Lunotriquetral Ligament Repair Using a Dorsal Approach

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate clinical and radiological results after screw fixation of the scaphoid and lunotriquetral ligament repair using a dorsal approach in the treatement of trans-scaphoid perilunate fracture dislocations.
Materials and Methods: From May 2003 to August 2007, 11 patients who underwent operative management of a trans-scaphoid perilunate fracture dislocation were included in this study. Average follow up period was 58 months.
In all patients, screw fixation of the scaphoid and lunotriquetral ligament repair with a suture anchor after open reduction was performed. Clinical evaluation was done by measuring range of motion and grip power and disabilities of arm, shoulder and hand (DASH) score evaluation for functional recovery at the last follow up. Union of scaphoid, change in lunotriquetral distance, and development of any instability and arthritis of wrist joint were radiographically assessed.
Results: In clinical outcomes, 89.3% recovery of grip power and 87.5% recovery of range of motion compared to healthy side were observed at the last follow-up. Average range of motions of extension, flexion, ulnar deviation, radial deviation, supination and pronation were 51.8˚, 58.4˚, 21.2˚, 16.2˚, 74.3˚, 75.1˚respectively. Average DASH score was 13.2. Bony union of scaphoid was achieved in all cases at the average of postoperative 19.3 weeks. Lunotriquetral distance after the operation and at the last follow up were 1.9 mm and 2.0 mm, respectively. There were no radiographic evidence of instability or arthritis.
Conclusion: Dorsal approach allows reduction of carpal bone, scaphoid fixation and lunotriquetral ligament repair in the treatment of trans-scaphoid perilunate fracture dislocations, providing satisfactory clinical and radiological results.

국문 초록 (Abstract)

목적: 주상골 골절을 동반한 월상골 주위 탈구에서 배측 접근법을 통해 주상골의 나사못 내고정과 월상-삼각 골간 인대의 봉합을 시행하고 임상적, 방사선학적 결과를알아보고자 하였다.
대상 및 방법: 2003년 5월부터 2007년 8월까지 주상골 경유 월상골 주위 탈구로 수술적 치료를 시행한 11명을 대상으로 하였다. 평균 추시 기간은 58±21.2개월이었다.
배측 접근법을 통해 주상골을 나사못으로 고정하고 월상골을 정복한 뒤 월상-삼각인대를 고정나사를 사용하여 봉합한 후 핀 고정술을 시행하였다. 임상적 결과는 최종추시에서 관절 운동 범위와 파악력을 건측과 비교하고, disabilities of arm, shoulder and hand (DASH) 점수를 통해 환자의 기능적 회복을 확인하였다. 방사선학적결과의 측정은 최종 추시에서 주상골의 유합 여부, 월상-삼각골 간격의 변화, 불안정성과 관절염의 발생 유무를 확인하여 판단하였다.
결과: 파악력은 건측에 비해 평균 89.3%의 회복을 보였으며, 관절 운동 범위는 건측에 비해 87.5%의 회복을 보였다. 평균 신전 범위는 51.8˚, 굴곡 범위는 58.4˚, 척측변위는 21.2˚, 요측 변위는 16.2˚, 회외전 범위는 74.3˚, 회내전 범위는 75.1˚이었다.
최종 추시에서 DASH 점수는 13.2점이었다. 주상골은 모든 예에서 평균 19.3주에 일차 골유합을 확인하였다. 평균 월상-삼각골 간격은 술후 1.9 mm였으며 최종 추시에서 2.0 mm로 측정되었다. 불안정성과 관절염이 발생한 예는 없었다.
결론: 주상골 경유 월상골 주위 골절 탈구에 대한 배측 접근법은 수근골의 정복과 주상골 고정, 월상- 삼각 골간 인대의 봉합을 원활하게 할 수 있으며 우수한 임상적, 방사선학적 결과를 얻을 수 있다.

참고문헌 (Reference)

1 Viegas SF, "Ulnar-sided perilunate instability: an anatomic and biomechanic study" 15 : 268-278, 1990

2 Inoue G, "Treatment of transscaphoid perilunate dislocations by internal fixation with the Herbert screw" 15 : 449-454, 1990

3 DiGiovanni B, "Treatment of perilunate and transscaphoid perilunate dislocations of the wrist" 24 : 818-826, 1995

4 Trumble T, "Treatment of isolated perilunate and lunate dislocations with combined dorsal and volar approach and intraosseous cerclage wire" 29 : 412-417, 2004

5 Shin AY, "Treatment of isolated injuries of the lunotriquetral ligament. A comparison of arthrodesis, ligament reconstruction and ligament repair" 83 : 1023-1028, 2001

6 Budoff JE, "Treatment of acute lunate and perilunate dislocations" 33 : 1424-1432, 2008

7 Adkison JW, "Treatment of acute lunate and perilunate dislocations" (164) : 199-207, 1982

8 Hee HT, "Transscaphoid perilunate fracture/dislocations: results of surgical treatment" 28 : 791-794, 1999

9 Moneim MS, "Transscaphoid perilunate fracture-dislocation. Result of open reduction and pin fixation" (190) : 227-235, 1984

10 Viegas SF, "Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation" 12 : 992-999, 1987

11 White RE Jr, "Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus" 9 : 181-184, 1984

12 Kim YJ, "Trans-scaphoid perilunate fracture-dislocations: results of open reduction and internal fixation of the scaphoid with a volar approach" 12 : 125-131, 2007

13 Knoll VD, "Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach" 30 : 1145-1152, 2005

14 Ritt MJ, "The lunotriquetral joint: kinematic effects of sequential ligament sectioning, ligament repair, and arthrodesis" 23 : 432-445, 1998

15 Trumble T, "Scaphoid nonunions. Pitfalls and pearls" 17 : 611-624, 2001

16 Apergis E, "Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases" 275 : 55-59, 1997

17 J Hand Surg Am, "Perilunate dislocations and fracture- dislocations: a multicenter study" 18 : 768-779, 1993

18 Kardashian G, "Perilunate dislocations" 69 : 87-96, 2011

19 Sotereanos DG, "Perilunate dislocation and fracture dislocation: a critical analysis of the volar-dorsal approach" 22 : 49-56, 1997

20 Green DP, "Open reduction of carpal dislocations: indications and operative techniques" 3 : 250-265, 1978

21 Moneim MS, "Management of greater arc carpal fractures" 4 : 457-467, 1988

22 Ritt MJ, "Lunotriquetral ligament properties: a comparison of three anatomic subregions" 23 : 425-431, 1998

23 Trumble TE, "Kinematics of the ulnar carpus related to the volar intercalated segment instability pattern" 15 : 384-392, 1990

24 Bedi A, "Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach: an assessment of radiographic and functional outcomes" 32 : 326-333, 2007

25 Trumble T, "Intercarpal arthrodesis for static and dynamic volar intercalated segment instability" 13 : 384-390, 1988

26 Cooney WP, "Difficult wrist fractures. Perilunate fracture-dislocations of the wrist" (214) : 136-147, 1987

27 Trumble T, "Carpal fracture-dislocations" American Academy of Orthopaedic Surgeons 2002

28 Herzberg G, "Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results" 27 : 498-502, 2002

29 Herzberg G, "Acute dorsal trans-scaphoid perilunate dislocations: open reduction and internal fixation" 4 : 2-13, 2000