Bond C D, Shin A Y, McBride M T, Dao K D
Naval Medical Center San Diego, California, USA.
J Bone Joint Surg Am. 2001 Apr;83(4):483-8. doi: 10.2106/00004623-200104000-00001.
Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work.
Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated.
Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups.
Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.
采用长时间石膏固定治疗无移位的舟状骨骨折，除了会导致恢复运动或工作的时间延迟外，还可能引起暂时的关节僵硬和肌肉无力。经皮空心螺钉固定舟状骨骨折可缩短骨折愈合时间以及恢复工作或运动的时间。这项前瞻性随机研究的目的是比较无移位舟状骨骨折采用石膏固定与经皮空心螺钉固定在影像学骨折愈合时间和恢复工作方面的差异。
25名患有急性无移位舟状骨腰部骨折的全职军事人员同意参与本研究，随机分为石膏固定组或采用经皮Acutrak空心螺钉（Acumed，比弗顿，俄勒冈州）固定组。评估骨折愈合时间、腕关节活动度、握力、恢复工作情况以及两年随访时患者的总体满意度。
11名患者随机接受经皮空心螺钉固定，14名患者随机接受石膏固定。螺钉固定组骨折愈合的平均时间为7周，而石膏固定组为12周（p = 0.0003）。患者恢复工作的平均时间为8周，而石膏固定组为15周（p = 0.0001）。在两年随访评估中，两组的腕关节活动范围或握力没有显著差异。两组患者的总体满意度都很高。
与石膏固定相比，经皮空心螺钉固定无移位舟状骨骨折可使影像学骨折愈合更快且能更快恢复军事任务。此类骨折经皮螺钉固定的具体适应症以及风险和益处必须在更大规模的随机前瞻性研究中确定。
