Ikeda Kazuo, Osamura Naoki, Tomita Katsuro
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
J Trauma. 2008 Dec;65(6):1453-8. doi: 10.1097/TA.0b013e31805824f3.
The most controversial problem in treating scaphoid fractures is whether bone grafts are necessary for cystic-type fractures.
We treated 105 scaphoid fractures using Herbert screws (1988-1997), AO 3.0 mm cannulated screws (1998-2002), and Acutrak screws (2003-2006). The patients ranged in age from 14 years to 67 years (average, 26 years). Our classifications were based on the radiographic findings: linear type (51 cases); cystic type (24 cases); and sclerotic or displaced type (30 cases). Linear and cystic types did not have any displacement more than 2 mm. If the fracture line had a sclerotic zone thicker than 1 mm, it was classified as sclerotic or displaced. The length of time before surgery did not affect the classification. Osteosynthesis was performed--without bone graft in all linear cases, with a bone graft in 7 and without a bone graft in 17 cases in cystic type, and with all bone graft in sclerotic or displaced type.
Bone union was achieved in all cases in linear type. There were one failure (AO) in 7 cases with bone graft and 3 failures (1 Herbert and 2 AO) in 17 cases without bone graft in cystic type. All 10 cases achieved bone union without bone graft in cystic type using Acutrak screw. There were two failure cases (2 AO) in sclerotic or displaced type.
Screw fixation without bone graft using Acutrak screws was a reliable strategy for the treatment of cystic-type scaphoid fractures.
治疗舟状骨骨折最具争议的问题是囊性骨折类型是否需要植骨。
我们使用Herbert螺钉（1988 - 1997年）、AO 3.0毫米空心螺钉（1998 - 2002年）和Acutrak螺钉（2003 - 2006年）治疗了105例舟状骨骨折。患者年龄从14岁到67岁不等（平均26岁）。我们的分类基于影像学表现：线形骨折（51例）；囊性骨折（24例）；硬化或移位骨折（30例）。线形和囊性骨折类型移位均不超过2毫米。如果骨折线有厚度超过1毫米的硬化区，则归类为硬化或移位骨折。手术前的时间长度不影响分类。进行了骨内固定——所有线形骨折病例均未植骨，囊性骨折类型中7例植骨、17例未植骨，硬化或移位骨折类型均植骨。
线形骨折类型所有病例均实现骨愈合。囊性骨折类型中，7例植骨的病例有1例失败（AO螺钉），17例未植骨的病例有3例失败（1例Herbert螺钉和2例AO螺钉）。使用Acutrak螺钉的囊性骨折类型中，所有10例未植骨的病例均实现骨愈合。硬化或移位骨折类型中有2例失败病例（2例AO螺钉）。
使用Acutrak螺钉进行无植骨的螺钉固定是治疗囊性舟状骨骨折的可靠策略。
