骨科英文书籍精读（138）｜舟骨-月骨脱位

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SCAPHO-LUNATE DISSOCIATION

A wrist sprain may be followed by persistent pain and tenderness over the dorsum just distal to Lister’s tubercle.

X-rays show an excessively large gap between the scaphoid and the lunate. The scaphoid may appear foreshortened, with a typical cortical ring sign. In the lateral view, the lunate is tilted dorsally and the scaphoid anteriorly (DISI pattern).

Treatment

Scapho-lunate instability causes weakness of the wrist and recurrent discomfort. If seen early (i.e. less than 4 weeks after injury) the scapho-lunate ligament should be repaired directly with interosseous sutures, protected by K-wires for 6 weeks and a cast for 8–12 weeks. If seen between 4 and 24 weeks, then the ligament is unlikely to heal. Blatt’s capsulodesis is helpful: a proximally based flap of dorsal capsule is attached to the back of the scaphoid to haul it back from flexion into a normal position. In chronic lesions without secondary osteoarthritis, a capsulodesis or ligament reconstruction is attempted. If there is severe symptomatic osteoarthritis then a limited intercarpal arthrodesis or radio-carpal arthrodesis is performed.

---from 《Apley’s System of Orthopaedics and Fractures》

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重点词汇整理：

dorsum美 /'dɔrsəm/n. 背部

Lister’s tubercle Lister’s 结节

tubercle /ˈtuːbərkl/n. （皮肤、骨头或植物上的）结节，疣粒，小块茎；（肺）结核结节

capsulodesis 关节囊固定术

flap /flæp/n. 拍打，拍打声；神经紧张；（飞机的）襟翼；风门，挡板；[医]皮瓣

haul /hɔːl/vt. （用力）拖，拉

lesion/ˈliːʒn/n. 损害；身体上的伤害；机能障碍

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百度翻译：

月骨游离

腕关节扭伤后可能伴有持续性疼痛和背部靠近李斯特结节的压痛。

X光显示舟骨和月骨之间的间隙过大。舟状骨可能出现缩短，典型的皮质环征。从侧面看，月骨向后倾斜，舟骨向前倾斜（DISI模式）。

治疗

肩胛月骨不稳导致手腕无力和反复不适。如果早期（即受伤后不到4周），肩胛骨-月骨韧带应直接用骨间缝线修复，用K形钢丝保护6周，石膏8-12周。如果在4到24周之间看到，那么韧带不太可能愈合。布拉特的囊膜融合术是有帮助的：背囊的近端皮瓣附着在舟状骨的背部，将其从屈曲状态拉回到正常位置。在没有继发性骨关节炎的慢性病变中，可以尝试囊融合术或韧带重建术。如果有严重的症状性骨关节炎，则可进行有限的腕关节间融合术或放射性腕关节融合术。

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