Abstract：
Background: Perilunate fracture-dislocations are frequently associated with a high risk of developing post-traumatic arthritis. Current studies indicate that during mid-term follow-ups, radiological signs of arthritis do not appear to correspond with functional score. The aim of this study was to assess the occurrence of posttraumatic arthritis and the wrist function after perilunate dislocations (PLD) and fracture dislocations at a mid-term follow-up of 7 years. Methods: We report the clinical and radiological outcomes of 17 wrists treated for PLD or fracture-dislocation by open reduction and internal fixation through a dorsal approach with dorsal ligament repair. Functional outcomes were evaluated using the short version of the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), the Patient-Rated Wrist Evaluation questionnaire (PRWE) and the Mayo Wrist Score (MWS). Results of radiographs were assessed using the Herzberg Radiological Scoring Chart. Results: The MWS showed five excellent, five good, five fair and two poor results with an average score of 81%. Radiological analysis using the Herzberg classification revealed midcarpal and/or radiocarpal arthritis in 65% of cases, lunate collapse in 59% and an increase in the mean ulnar translocation ratio in 53% of the cases. Complications included one case of lunate osteonecrosis and one case of stage 3 scapholunate advanced collapse that required revision surgery. Conclusions: Although the clinical and functional outcomes are favourable at mid-term follow-up, radiological evaluation shows a progression towards osteoarthritis (OA). Further research is warranted to refine treatment strategies and investigate factors influencing the development of OA. Level of Evidence: Level IV (Therapeutic).
摘要：
背景：骨周骨折脱位通常与发生创伤后关节炎的高风险相关。目前的研究表明，在中期随访期间，关节炎的放射学征象似乎与功能评分不一致。这项研究的目的是在7年的中期随访中评估外伤性关节脱位（PLD）和骨折脱位后创伤后关节炎的发生和腕关节功能。方法：我们报告了通过背侧韧带修复的背侧入路切开复位内固定治疗PLD或骨折脱位的17个手腕的临床和放射学结果。使用简短版本的手臂快速残疾评估功能结果，肩和手问卷（QuickDASH），患者评估腕部评估问卷（PRWE）和Mayo腕部评分（MWS）。使用Herzberg放射学评分图评估X射线照片的结果。结果：MWS表现为5优，五好,5个成绩一般，2个成绩差，平均得分为81%。使用Herzberg分类的放射学分析显示65％的病例中腕和/或radi腕关节关节炎，59%的月肉塌陷和53%的平均尺骨易位率增加。并发症包括1例月骨坏死和1例需要翻修手术的3期肩胛骨晚期塌陷。结论：虽然临床和功能结果在中期随访是有利的，放射学评估显示骨关节炎（OA）的进展。需要进一步的研究来完善治疗策略并调查影响OA发展的因素。证据级别：IV级（治疗）。
