Abstract：
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
摘要：
肩胛骨关节损伤是腕关节不稳定的最常见原因。这些损伤的后遗症造成了相当大的发病率，如果不及时治疗，可能导致肩cap骨的晚期塌陷和腕骨的进行性恶化。肩胛骨间韧带的破裂及其关键稳定器会导致舟骨和月骨之间的不同步运动。额外的韧带损伤或衰减会导致舟骨旋转半脱位和肩胛骨间隙增加。对肩胛骨不稳定的干预旨在通过恢复韧带完整性和使腕运动学正常化来停止退行性过程。在本综述的第一部分，我们讨论解剖学，运动学,肩胛骨韧带及其关键韧带稳定剂的生物力学特性。我们为理解肩胛骨韧带不稳定的频谱提供了基础，并纳入了影响治疗考虑的有意义的新解剖学见解。目的是提供有关肩胛骨韧带复合体解剖结构的更新，腕骨近端的关键韧带稳定器的重要性，引入手术暴露舟骨和月骨的安全技术，以及与肩胛骨离解治疗有关的病理解剖学。在本综述的第二部分，我们提出了一种基于损伤阶段的新型韧带治疗算法，韧带损伤的程度和性质，和关节炎变化的存在。
