Cooney William P
Mayo Medical School, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Instr Course Lect. 2003;52:197-208.
Scaphoid fractures are among the most common fractures of the bones of the wrist and usually result from a forceful extension of the wrist. If the diagnosis cannot be established by clinical and radiographic examination, bone scans are recommended and are preferred over tomography or MRI, which are more expensive diagnostic procedures. Scaploid fractures should be classified as either undisplaced, stable or displaced, unstable. Nonsurgical treatment with cast immobilization (short arm-thumb spica cast) is recommended for stable fractures; however, there is increased interest in percutaneous screw (or pin) fixation. The recommended treatment for unstable scaphoid fractures is open reduction and screw fixation. Closed reduction and percutaneous screw or pin fixation can be considered in minimally displaced or reducible fractures, whereas open reduction is recommended for all other displaced fractures. The following treatment protocols are recommended: (1) bone scan or, if necessary, tomography for early diagnosis; (2) percutaneous screw fixation of nondisplaced or minimally displaced scaphoid fractures as an alternative to treatment with a thumb spica cast; (3) open reduction of displaced scaphoid fractures; (4) early mobilization of stable fractures after internal fixation; and (5) the possible use of a playing splint after athletic injuries when secure internal fixation is achieved.
舟骨骨折是腕部骨骼最常见的骨折之一，通常由腕部强力伸展所致。如果临床和影像学检查无法确诊，则建议进行骨扫描，且骨扫描优于断层扫描或磁共振成像（MRI），因为后两者是更昂贵的诊断方法。舟骨骨折应分为无移位、稳定型或移位、不稳定型。对于稳定型骨折，建议采用石膏固定（短臂拇指人字形石膏）进行非手术治疗；然而，经皮螺钉（或钢针）固定越来越受到关注。不稳定舟骨骨折的推荐治疗方法是切开复位螺钉固定。对于轻度移位或可复位的骨折，可考虑闭合复位及经皮螺钉或钢针固定，而对于所有其他移位骨折，则建议切开复位。推荐以下治疗方案：（1）进行骨扫描，必要时进行断层扫描以早期诊断；（2）对于无移位或轻度移位的舟骨骨折，经皮螺钉固定可作为拇指人字形石膏治疗的替代方法；（3）对移位的舟骨骨折进行切开复位；（4）内固定后对稳定型骨折尽早进行活动；（5）在运动损伤后，若实现了可靠的内固定，可考虑使用运动夹板。
