雙側腕部急性損傷：經舟狀骨與月狀骨周圍骨折脫位合併對側月狀骨脫臼－個案報告與文獻回顧

Bilateral Wrist Trauma: Trans Scaphoid Perilunate Fracture-Dislocation and Contralateral Lunate Dislocation: A Case Report and Review of Literature

陳昱彰(Yu-Chang Chen) ； 林家麟(Chia-Lin Lin) ； 陳宏明(Hung-Ming Chen)

《北市醫學雜誌》 13卷2期 (2016/06) Pp. 220-225

https://doi.org/10.6200/TCMJ.2016.13.2.12

摘要

腕骨損傷，多因為車禍或高處跌落手掌支撐身體等高能量外力所造成。我們提出一例特殊病例，男子車禍造成左側月狀骨周圍脫位併舟狀骨骨折，右側月狀骨脫臼，屬於非常罕見的雙側手腕骨折脫臼病例。入院時，雙手食指中指有麻痺感，腕部腫脹，正中神經因月狀骨的脫位而遭受到壓迫，緊急施行脫臼復位。次日由背側入路施行舟狀骨骨折復位固定與月狀骨脫臼復位舟月韌帶之修補手術。急性舟狀骨骨折及月狀骨周圍脫臼，是否需要手術介入，治療方式仍有爭議，就近年許多研究顯示，手術治療，統計上預後比非手術治療好，雖未有定論，目前傾向手術治療。

關鍵字

經舟骨月骨周圍骨折脫位 ； 月狀骨脫臼 ； 舟狀骨骨折

並列摘要

Trans-scaphoid perilunate fracture-dislocation and lunate dislocation are uncommon. These injuries are mainly seen in patients who sustained high energy traumas such as traffic or fall accident. A rare both-wrist injured male patient came to the hospital after traffic accident with trans-scaphoid perilunate fracture-dislocation on his left wrist and lunate dislocation on his right. Numbness in bilateral index and middle finger, deformity and swelling of both wrists were also noted on admission. Under the impression of acute carpal tunnel syndrome, closed reduction was performed immediately. The open reduction and internal fixation (ORIF) and ligament repair were managed on the next day. Trans-scaphoid perilunate fracture-dislocation can be treated either by closed reduction with casting (non-surgical) or ORIF (surgical). Still, there are debates over the treatment for trans-scaphoid perilunate fracture-dislocation. However, several recent studies and case reports have showed that the prognosis of surgical treatment is better non-surgical treatment in trans-scaphoid perilunate fracture-dislocation. Although this remains inconclusive, surgical treatment has been used in most cases.

並列關鍵字

trans-scaphoid perilunate fracture-dislocation ； lunate dislocation ； scaphoid fracture