Clementson Martin, Jørgsholm Peter, Besjakov Jack, Thomsen Niels, Björkman Anders
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
J Hand Surg Am. 2015 Jul;40(7):1341-8. doi: 10.1016/j.jhsa.2015.03.007. Epub 2015 Apr 22.
To evaluate clinical and radiological outcomes after conservative treatment and arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures in a randomized controlled trial.
Consecutive patients with acute non- or minimally displaced scaphoid waist fractures were prospectively randomized to conservative or surgical treatment. All patients were screened using radiographs, computed tomography, and magnetic resonance imaging. Conservative treatment consisted of a below-elbow thumb spica cast until radiological signs of union appeared. Surgical treatment consisted of wrist arthroscopy and percutaneous antegrade screw fixation. Clinical examination, radiographs, and computed tomography were used to follow the patients. Twenty-four patients were treated conservatively and 14 patients underwent surgery. The patients were followed at regular intervals for 1 year after surgery. Twenty-one patients treated conservatively and 14 treated surgically were available for follow-up after a median of 6 years (range, 4-8 y).
At 26 weeks, the conservatively treated group had significantly better range of motion and had reached almost normal value compared with the contralateral wrist. There were no significant differences between the 2 groups concerning grip or pinch strengths at any measure point. At follow-up after a median of 6 years, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group (3 of 14) than in the conservative group (2 of 21).
Non- and minimally displaced scaphoid waist fractures are best treated conservatively. Operative treatment may provide an improved functional outcome in the short term but at the price of a possible increased risk of arthritis in the long term.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
在一项随机对照试验中，评估急性无移位或轻微移位的舟状骨腰部骨折经保守治疗和关节镜辅助螺钉固定后的临床和影像学结果。
将连续的急性无移位或轻微移位的舟状骨腰部骨折患者前瞻性随机分为保守治疗组或手术治疗组。所有患者均通过X线片、计算机断层扫描和磁共振成像进行筛查。保守治疗包括使用肘下拇指人字形石膏固定，直至出现骨折愈合的影像学征象。手术治疗包括腕关节镜检查和经皮顺行螺钉固定。采用临床检查、X线片和计算机断层扫描对患者进行随访。24例患者接受保守治疗，14例患者接受手术治疗。术后定期对患者进行随访，为期1年。保守治疗的21例患者和手术治疗的14例患者在中位随访6年（范围4 - 8年）后仍可供随访。
在26周时，与对侧手腕相比，保守治疗组的活动范围明显更好，几乎达到正常水平。在任何测量点，两组之间的握力或捏力均无显著差异。在中位随访6年后，桡舟关节关节炎的影像学征象在手术治疗组（14例中的3例）比保守治疗组（21例中的2例）更常见。
无移位和轻微移位的舟状骨腰部骨折最好采用保守治疗。手术治疗可能在短期内改善功能结局，但长期来看可能会增加患关节炎的风险。
研究类型/证据水平：治疗性II级。
