- 期刊
- Ahead-of-Print
經舟狀骨骨折與月狀骨周圍脫位之介入與預後－文獻回顧與經驗分享
The Intervention and Outcomes of Trans-scaphoid Perilunate Fracture-dislocation-Review of Literature and Experience Sharing
摘要
經舟狀骨骨折與月狀骨周圍脫位（trans-scaphoid perilunate fracture-dislocation, TSPFD）多因車禍、高處跌落或運動等高能量外力而導致病人骨骼與韌帶損傷，進而造成個案手腕及前臂關節角度受限、肌力下降，甚至影響其日常生活功能與工作回歸。開放性復位為目前常見的手術選擇，病人術後也需固定6-8週並視復原情形給予漸進復健運動。多數TSPFD病人可恢復至足夠的關節角度與力量，最早於傷後12週，部分病人可不受限的日常使用其患側手，但要完全恢復至病前狀態較為困難，也需5-6個月的時間方能返回職場或相同報酬的工作。為降低病人後續併發症與增進其預後表現，及早診斷、正確手術介入、鼓勵病人使用手部與及早復健介入是重要的關鍵要素。本文將針對TSPFD之發生原因、介入方法、併發症與其預後表現進行文獻回顧，並以筆者之經驗分享介入之要點。
並列摘要
Trans-scaphoid perilunate fracture-dislocation (TSPFD) is generally caused by high-energy trauma such as car accidents, a fall from a height, or injury during sporting activities resulting in bony and ligamentous damage, limited range of motion of the wrist and forearm, decreased muscle strength, and even affecting daily life and return to work. Open reduction is the current preference of surgery that requires immobilization for 6-8 weeks after operation, and gradual rehabilitation exercises are given depending on the healing condition. Despite TSPFD patients can recover to adequate joint angles and grip strength and some can unrestrictly use the affected hand in daily activities as early as 12 weeks after surgery, a full recovery to the pre-illness state is rather difficult, and it takes 5-6 months to get back to workplace or a job with the same salary. Early diagnosis and correct surgical intervention, encouraging patients to use their hands, and early intervention of rehabilitation are critical for preventing complications and improving prognosis among the patients. This article reviews the literature on the causes, interventions, complications, and outcomes of TSPFD, and shares the key points of intervention based on the authors' experiences.