Beutel F K, Wilhelm K
Sektion Hand- und Mikrochirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg.
Handchir Mikrochir Plast Chir. 1999 May;31(3):207-11. doi: 10.1055/s-1999-13522.
Usually, untreated scaphoid fractures lead to non-union and partial or complete avascular necrosis. The purpose of our study was to examine the influence of location and fracture line on the pattern of necrosis. Therefore, 85 patients with scaphoid non-union were examined by enhanced highfield MRI. Fractures were classified by location and fracture line. A staging system based on signal intensity in T1-weighted spin-echo sequences in enhanced MRI was used to evaluate extent and location of avascular necrosis, which was found in 81% of our patients. In our patients, viability of the scaphoid was independent of the fracture line without dominance of vertical oblique fractures (2%). Based on our staging system, signal intensity as a sign of fragment viability was reduced in the proximal fragment in 46 patients, whereas in eight patients the distal fragment showed reduced viability. In 26 patients, no difference was found between proximal and distal fragments. Fractures proximal to the transition of middle to distal third showed less viability of the proximal fragment, not dependent of how proximal the fracture was seen. In triple fractures (6%) signal intensity of scaphoid bone was more reduced in enhanced MRI.
通常情况下，未经治疗的舟骨骨折会导致骨不连以及部分或完全性缺血性坏死。我们研究的目的是探讨骨折部位和骨折线对坏死模式的影响。因此，对85例舟骨骨不连患者进行了增强型高场MRI检查。根据骨折部位和骨折线对骨折进行分类。采用基于增强MRI中T1加权自旋回波序列信号强度的分期系统来评估缺血性坏死的范围和部位，在我们的患者中，81%发现了缺血性坏死。在我们的患者中，舟骨的存活情况与骨折线无关，垂直斜形骨折占比不高（2%）。根据我们的分期系统，46例患者近端骨折块的信号强度作为骨折块存活的标志降低，而8例患者远端骨折块显示存活能力降低。26例患者近端和远端骨折块之间未发现差异。在中、远1/3交界处近端的骨折，近端骨折块的存活能力较低，与骨折的近端程度无关。在三骨折（6%）中，增强MRI显示舟骨的信号强度降低更明显。
