Kawamura Kenji, Chung Kevin C
Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
J Hand Surg Am. 2008 Jul-Aug;33(6):988-97. doi: 10.1016/j.jhsa.2008.04.026.
Scaphoid fractures are common but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Improvements in diagnosis, surgical treatment, and implant materials have encouraged a trend toward early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions.
舟骨骨折很常见，但由于骨折的特殊几何形状和舟骨脆弱的血管分布模式，带来了独特的挑战。急性舟骨骨折的诊断延误和治疗不充分可导致骨不连及随后的腕关节退行性关节炎。诊断、手术治疗和植入材料方面的改进促使了早期内固定的趋势，即使对于可能采用非手术治疗的无移位舟骨骨折也是如此。尽管出现了新开发的固定技术，包括开放固定和经皮固定，但舟骨骨折手术治疗后的骨不连率仍高达10%。舟骨骨不连可伴有或不伴有近端极的缺血性坏死，在X线片上可能显示驼背畸形。如果不进行治疗，舟骨骨不连可发展为腕骨塌陷和退行性关节炎。手术治疗旨在通过切开复位和植骨内固定来纠正畸形。最近，带血管蒂骨移植在舟骨骨不连的治疗中越来越受欢迎，特别是在伴有缺血性坏死的病例中。本文综述了有关舟骨骨折和骨不连治疗的当前概念。
