Palmar Dislocation of the Trapezoid and the Capitate-A Case of Traumatic Peritrapezoid, Pericapitate Axial Dislocation of the Carpus

本篇報告壹例小多角骨及頭狀骨向掌側脫臼合併正中神經壓迫的病例，這是一種少見的合併橈側及尺側軸型脫臼（axial-radialulnar dislocation）。患者是34歲女性，右手因操作冲床機器壓傷，初期治療包括掌側筋膜切開術（palmar fasciotomy）及腕隧道切開術（carpal tunnel release），繼以徒手整復，骨釘（K-wire）及石膏固定。術後病程順利，惜因X光判讀疏忽，脫位之腕骨，並未得到完全復位。經過四年的追踪觀察，患者回到受傷前之工作，並無疼痛或工作障礙，其受傷右腕之活動範圍，屈曲為30 度（palmar flexion），伸展為70度（dorsiflexion）。受傷右手握力24公斤，左手握力25公斤。依照梅約診所庫里醫師等之評估標準（Cooney WP et al.），可得到80分之臨床評分，與常見的半月狀骨周圍腕骨脫臼比較（perilunate dislocation），是屬於好的結果。由本例之結果及回顧文獻的報告，我們認為治療腕部軸型脫臼時，軟組織的細心檢查，妥善保護與腕骨的解剖復位，在預後上有同等重要的影響。

關鍵字

軸型脫臼；掌側面脫臼；橈側尺側軸型脫臼

並列摘要

In this report, we describe a case of palmar dislocation of both the trapezoid and the capitate, It is a combined axial-radial-ulnar dislocation (ARU) of the carpus associated with median nerve compression.Management of this patient included palmar fasciotomy with release of the carpal tunnel, closed manipulation with K-wire fixation, and splint immobilization. Unfortunately, the dislocated carpal bones were not anatomically reduced, which may be due to improper interpretation of the postoperative X-ray film.After 4 years of follow-up , the patient is free of symptoms and back to her previous work; the range of motion of the right injured wrist measured 30° in palmar flexion and 70° in dorsiflexion. The grip strength measured 24 kgs on the right injured hand and 25 kgs on the left normal hand. A clinical rating (the method reported by Cooney WP et al) of 80 was obtained, which is a good result. Careful evaluation and meticulous preservation of the injured 80ft tissues as well as the anatomical skeletal reduction are improtant in treating this type of injury.

並列關鍵字

Axial dislocation ； Palmar dislocation ； Axial-radial-ulnar dislocation

國際替代計量

Palmar Dislocation of the Trapezoid and the Capitate-A Case of Traumatic Peritrapezoid, Pericapitate Axial Dislocation of the Carpus

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