使用腕部Navicular view X-光投影診斷經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位

Using wrist navicular view to diagnose trans-scaphoid perilunate fracture combined with distal radioulnar joint dislocation: a case report

經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位（Trans-scaphoid perilunate fracture combined with distal radioulnar joint dislocation）是一種相對罕見的腕部外傷，在緊急情況下容易造成誤判而延誤治療時機，影響最終治療效果。診斷困難的可能原因是使用腕部X光正投影及正側面投影（腕部AP和Lat投影圖）較難顯示出手腕舟狀骨的骨折情形。作者在門診中使用腕部舟狀骨投影（Wrist Na-vicular View）篩檢由急診室轉診的腕部外傷病患，診斷出一位經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位案例。該女性患者的腕部AP和Lat投影圖檢查結果均為正常，本文對患者隨後的X光檢查結果和追蹤過程進行了分析。雖然治療此類型的骨科案例多以外科手術治療為主，但該案例接受手術治療意願偏低，因此只進行了石膏固定治療,其最終仍獲得良好成果。在緊急情況下，傳統的腕關節X光正投影及正側面投影通常已足以篩檢舟狀骨折情形，但針對隱匿性骨病變仍有遺漏的可能。本研究強調使用輔助性Wrist Navicular View對於診斷該類型案例的價值。

 

Trans-scaphoid perilunate fracture combined with distal radioulnar joint dislocation is a relatively rare wrist trauma condition and often missed in emergency setting. Traditional wrist anterior posterior and lateral Views X-ray are usually sufficient for screening writ injuries in emergency room, but occult bony lesions like these were occasionally missed out. Adjunct X-ray check with wrist navicular view would help tremendously in filling the gap.