| Objective:To compare the clinical effects of open reduction and internal fixation between volar and dorsal surgical approach for Trans-Scaphoid Perilunate Dislocation(Trans-Scaphoid Perilunate Dislocation,TSPD).Methods:The subjects included in this study were 42 patients with Trans-Scaphoid Perilunate Dislocation were treated at Hand and Foot Surgery of Subei People?Hospital from December 2012 to December 2018.42 patients were divided into palmar approach group(group A)and dorsal approach group(group B).Palmar group:Of the21 cases,19 were males and 2 were females,aged 23 to 61 years,with an average(37.90±11.12)years,6 cases of traffic accident injuries,8 cases of fall injuries and 7cases were accidental fall injuries.According to the time from injury to surgery:18cases were of fresh TSPD,3 cases were of old TSPD.According to Mayo classification of scaphoid fractures:14 cases were of lumbar fractures,3 cases were of distal articular surface fractures and 4 cases were of distal 1/3 fractures.TSPD dislocation type:21cases of dorsal dislocations.10 were on the left hand,11 were on the right hand.The hospital stay was 8 to 26 days,with an average of(11.86±4.28)days.Dorsal group:Of the 21 cases,20 were male and 1 was female,aged between 17 to 67 years,with an average(37.05±13.73)years.5 cases were of traffic accident injuries and 6 cases of fall injuries,10 cases were accidental falls.According to the time from injury to surgery:16cases were of fresh TSPD,5 cases were of old TSPD.According to Mayo classification of scaphoid fractures:15 cases of lumbar fractures,4 cases of distal articular surface fractures,2 cases of distal 1/3 fractures.TSPD dislocation type:21 cases of dorsal dislocations.13 were on left hand and 8 were on the right hand.The length of hospital stay was between 7 to 25 days,with an average of(12.48±4.87)days.In the both group of patients,wrist scaphoid fractures were fixed with hollow compression countersunk screws.If the fracture is an old fracture,the patient's autologous iliac bone graft was used during the operation and the dislocated wrist bone was internally fixed with Kirschner wire.Injured nerves,joint capsules and ligaments were repaired during the operation.Inclusion criteria:(1)diagnosis of transsphenoidal peri-lunar dislocation by X-ray,CT,MRI;(2)all non-pathological fractures of scaphoid;(3)generally good,can withstand surgery;(4)patients have good compliance,Can actively cooperate with surgical treatment.Exclusion criteria:(1)pathological scaphoid fracture;(2)poor compliance without treatment;(3)severe osteoporosis;(4)traumatic arthritis;(5)systemic multiple system disease intolerance to surgical treatment.The retrospective comparison of the curative effects of two different surgical approaches for TSPD by the same chief physician was included in this subject.There were no statistically significant differences in gender,left and right sides of the affected limb,age,type of carpal scaphoid fracture,type of TSPD dislocation,cause of injury,and time between injury and surgery.(P>0.05).Intraoperative bleeding volume,healing time of scaphoid fractures,length of hospital stay,and improved Mayo wrist function scores(preoperative,postoperative 6 months,postoperative 12 months),excellent and good rates,complications were compared between the two groups.All the data in this subject were processed using SPSS 22.0 statistical software.Among them,the patient's age,bone healing time and other measurement data were analyzed by t test,expressed as mean±standard deviation(?x±s).For wrist function The scoring excellent rate[n(%)],surgical complication rate[n(%)]and other count data were compared using the X~2test(Note:P<0.05 has statistical significance).Results:Based on data analysis of intraoperative blood loss,complications,postoperative outpatient review and follow-up to 12 months in 42 TSPD patients,intraoperative blood loss was(14.52±9.86)ml in the palmar approach group and(20.48±14.65)ml in the dorsal group.with intraoperative blood loss in the palmar approach group was lower than the dorsal group,with a significant difference(P<0.05).The fracture healing time in the palmar approach group was(10.88±1.07)weeks,in the dorsal approach group was(11.56±1.03)weeks.The fracture healing time in the palmar approach group was shorter than the dorsal side,with significant difference(P<0.05).The average length of hospital stay was(11.86±4.28)days in the palmar group and(12.48±4.87)days in the dorsal group.There was no significant difference in the length of stay between the two groups(P>0.05).The Mayo score of the palmar approach group was(41.43±6.35)points preoperatively and(89.52±7.89)points 12 months after operation respectively.The Mayo score of the dorsal approach group preoperatively and12 months postoperatively was(43.52±5.64)and(87.62±8.89)points.Mayo scores were not statistically significant preoperatively and 12 months postoperatively(P>0.05).But Mayo scores 6 months after operation in the palmar approach group(83.57±13.05)points significantly higher than the dorsal approach group(74.05±15.54)points,the difference between the two groups was statistically significant(P<0.05).The superior rate of wrist function in the palmar approach group and the dorsal approach group after12 months was 95.23%and 85.71%respectively.There was no significant difference between the two groups(P>0.05).But 6 months after the operation,the rate of excellent wrist function in the palmar approach group was significantly higher to the dorsal approach group and the difference between the two groups was statistically significant(P<0.05).In terms of complications,1 case of vascular injury(vascular wall rupture)and 1 case of infection at the incision site occurred in the palmar approach group with a complication rate of 9.52%;In the dorsal approach group,2 vascular injuries(vascular wall rupture)occurred,1 case of fracture healing with deformity,1 case of infection at the incision site,the complication rate was 19.05%.After statistical analysis of the two groups,there was no significant difference(P>0.05)in the complications.Conclusion:To sum up,both the palmar approach and the dorsal approach are effective treatments for TSPD,but the fracture healing time of the palmar approach group is shorter than that of the dorsal approach group.According to Mayo score excellent and good rate achieved were significantly higher in the palmar group than those of the dorsal approach group.The palmar approach for TSPD was a better and preferrable surgical approach. |
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