骨科英文书籍精读（139）｜剩余腕关节脱位类型
TRIQUETRO-LUNATE DISSOCIATION
A medial sprain followed by weakness of grip and tenderness distal to the head of the ulna should suggest disruption of the triquetro-lunate ligaments. X-rays show a noticeable gap between the triquetrum and the lunate, with a VISI carpal collapse pattern in the lateral view.
Treatment
Acute tears should be repaired with interosseous sutures, supported by temporary K-wires for 6 weeks and a cast for 8–12 weeks. In chronic injuries, a ligament substitution (e.g. a slip of extensor carpi ulnaris) or a limited intercarpal fusion may be considered.
RADIO-CARPAL DISLOCATION
The most common injuries of this type involve a fracture of the anterior or posterior rim of the distal radius (Barton’s fracture – see page 776). However, occasionally the ligaments which bind the carpus to the distal radius can rupture; the carpus tends to translate medially. Repair of the ligaments and temporary K-wire stabilization is needed.
MIDCARPAL DISLOCATION
The extrinsic ligaments which bind the proximal to the distal row can rupture (there are, by definition, no intrinsic ligaments between these two rows). The diagnosis is difficult but is more readily suggested in those with generalized ligament laxity and a chronic wrist problem. The patient complains of a painful, recurrent snap in the wrist; the two rows can be passively ‘clunked’ apart when shifted backwards and forwards. If an acute ligament rupture is diagnosed, then repair and temporary K-wire stabilization should be carried out. In a chronic lesion, fusion of the proximal row to the distal row is the most effective treatment but this operation will restrict wrist movement and may predispose to later arthritis.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
suture /ˈsuːtʃər/n. 缝合；缝合处；缝合用的线vt. 缝合
rupture /ˈrʌptʃər/n. 破裂；决裂；疝气vt. 使破裂；断绝；发生疝vi. 破裂；发疝气
extrinsic /eksˈtrɪnzɪk,eksˈtrɪnsɪk/adj. 外在的；外来的；非固有的
intrinsic /ɪnˈtrɪnzɪk,ɪnˈtrɪnsɪk/adj. 本质的，固有的
by definition,按照定义；当然地；明显地
predispose /ˌpriːdɪˈspoʊz/vt. 预先处置；使…偏向于
百度翻译：
三角骨-月骨脱位
尺骨头部远端的内侧扭伤、握力无力和十度扭伤应提示月骨三角韧带断裂。X光片显示三个月骨和月骨之间有明显的间隙，侧视图可见腕关节塌陷。
治疗
急性撕裂应采用骨间缝线修补，并用临时K形钢丝支撑6周，石膏8-12周。在慢性损伤中，可以考虑韧带下固定（如尺侧腕伸肌滑脱）或有限的腕骨间融合。
桡腕关节脱位
这种类型最常见的损伤包括桡骨远端前缘或后缘骨折（巴顿骨折-见776页）。然而，偶尔将腕关节与桡骨远端相连的韧带会断裂，腕关节倾向于向内侧移位。韧带的修复和速度的K-线稳定是必要的。
腕中段脱位
将近端与远端行结合的外源性韧带可能断裂（根据定义，这两行之间没有内在韧带）。诊断是困难的，但更容易建议那些有广泛韧带松弛和慢性手腕问题。患者抱怨手腕疼痛，反复发作；当向后或向前移动时，两排可能会“咔嚓”地分开。如果诊断为急性韧带断裂，则应进行修复和临时K线固定。在慢性病变中，近端行与远端行融合是最有效的治疗方法，但这种手术会限制手腕的活动和可能易患晚期关节炎。