Martus Jeffrey E, Bedi Asheesh, Jebson Peter J L
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor 48109, USA.
Tech Hand Up Extrem Surg. 2005 Dec;9(4):202-6. doi: 10.1097/01.bth.0000191422.26565.25.
Scaphoid fractures are common in the young, active patient. Treatment is challenging because of the complex three-dimensional anatomy of the scaphoid and the tenuous blood supply. Traditionally, cast immobilization has been used for the management of non-displaced fractures with satisfactory outcomes reported in the literature. However, non-surgical treatment may result in a delayed union or nonunion particularly if the fracture is unstable, displaced, or involves the proximal pole. Recently there has been increased interest in the fixation of non-displaced scaphoid fractures. The proposed advantages for operative treatment include avoiding the morbidity and inconvenience of prolonged cast immobilization and a lower incidence of delayed union or nonunion. A variety of surgical approaches for fixation of an acute scaphoid fracture have been described. The most common techniques include percutaneous fixation, arthroscopically assisted reduction and fixation, or open reduction and internal fixation via a volar approach. The senior author favors a limited dorsal approach with compression screw fixation of all proximal pole fractures as well as displaced and non-displaced fractures of the waist region. The technique is simple permitting accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union.
舟骨骨折在年轻、活跃的患者中很常见。由于舟骨复杂的三维解剖结构和脆弱的血液供应，治疗具有挑战性。传统上，石膏固定一直用于治疗无移位骨折，文献报道其结果令人满意。然而，非手术治疗可能会导致延迟愈合或不愈合，特别是如果骨折不稳定、移位或累及近端极。最近，人们对无移位舟骨骨折的固定越来越感兴趣。手术治疗的潜在优势包括避免长期石膏固定带来的不适和不便，以及降低延迟愈合或不愈合的发生率。已经描述了多种用于急性舟骨骨折固定的手术方法。最常见的技术包括经皮固定、关节镜辅助复位和固定，或通过掌侧入路进行切开复位内固定。资深作者倾向于采用有限的背侧入路，对所有近端极骨折以及腰部区域的移位和无移位骨折进行加压螺钉固定。该技术简单，能够在舟骨的中心轴上准确放置螺钉，这在生物力学上具有优势，并且对于实现愈合很重要。
