McAdams Timothy R, Srivastava Sakti
Division of Hand and Upper Extremity Surgery, Stanford University Hospital, Palo Alto, California 94304, USA.
Arthroscopy. 2004 Feb;20(2):152-7. doi: 10.1016/j.arthro.2003.11.023.
The purpose of this article is to arthroscopically evaluate the effect of forearm rotation on scaphoid fracture displacement and the impact of intra-articular ligament sectioning.
Controlled laboratory study.
Scaphoid fracture stability is studied arthroscopically in 10 cadaveric upper limbs. Displacement of the osteotomized scaphoid with and without forearm rotation is arthroscopically evaluated before and after radioscaphocapitate (RSC) ligament sectioning.
No rotation at the fracture site was identified in full pronation and full supination with the wrist immobilized. With the RSC ligament intact, no immobilization, and the wrist fully pronated, 25% of scaphoid fractures rotated less than 1 mm, 62.5% rotated 1 to 2 mm, and 12.5% rotated more than 2 mm. After sectioning the RSC ligament, the fully pronated wrist resulted in rotation of less than 1 mm in 75% and 1 to 2 mm in 25%. No rotation at the fracture site was seen with supination, with or without immobilization. No difference was found between loaded and unloaded trials.
Based on this observational data, it appears safe to use a below-elbow thumb spica cast in the treatment of minimally displaced scaphoid waist fractures. Sectioning of the RSC ligament resulted in reduced amount of rotation at the scaphoid waist fracture; thus the RSC ligament may be a deforming force rather than a stabilizing force in scaphoid waist fractures. Arthroscopy may be a valuable tool in the study of the effect of ligament sectioning on fracture stability.
本文旨在通过关节镜评估前臂旋转对舟骨骨折移位的影响以及关节内韧带切断的影响。
对照实验室研究。
对10具尸体上肢进行关节镜下舟骨骨折稳定性研究。在桡舟头韧带（RSC）切断前后，通过关节镜评估截骨舟骨在有无前臂旋转情况下的移位情况。
在腕关节固定时，完全旋前和完全旋后位骨折部位均未发现旋转。RSC韧带完整、未固定且腕关节完全旋前时，25%的舟骨骨折旋转小于1mm，62.5%旋转1至2mm，12.5%旋转大于2mm。切断RSC韧带后，完全旋前的腕关节75%旋转小于1mm，25%旋转1至2mm。旋后位时，无论是否固定，骨折部位均未见旋转。加载和未加载试验之间未发现差异。
基于这些观察数据，对于治疗轻度移位的舟骨腰部骨折，使用肘下拇指人字形石膏似乎是安全的。切断RSC韧带可减少舟骨腰部骨折的旋转量；因此，RSC韧带在舟骨腰部骨折中可能是一种致伤力而非稳定力。关节镜检查可能是研究韧带切断对骨折稳定性影响的一种有价值的工具。
