Schwarcz Yonatan, Schwarcz Yael, Peleg Eran, Joskowicz Leo, Wollstein Ronit, Luria Shai
1Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 2School of Engineering and Computer Science, the Hebrew University, Jerusalem, Israel 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Bone Joint Surg Am. 2017 Jan 18;99(2):141-149. doi: 10.2106/JBJS.16.00021.
Our goal was to analyze the movement of acute scaphoid waist fracture fragments and adjacent bones in a common coordinate system. Our hypothesis was that the distal scaphoid fragment flexes and pronates and the proximal fragment extends.
Computed tomography (CT) scans of patients diagnosed with an acute scaphoid waist fracture were evaluated using a 3-dimensional (3D) model. The scans of 57 nondisplaced and 23 displaced fractures were compared with a control group of 27 scans showing no pathological involvement of the wrist. Three anatomical landmarks were labeled on the distal and proximal fragments of the scaphoid, the lunate, and the trapezium. Each set of labels formed a triangle representing the bone or fragment. Four landmarks were labeled on the distal radial articular surface and used to create a common coordinate system. The position of each bone or fragment was calculated in reference to these coordinates.
The displaced fracture group showed significant extension, supination, and volar translation of the proximal scaphoid fragment when compared with the other groups. The lunate tended toward a supinated position, which was not statistically significant. The distal scaphoid fragment and the trapezium showed no movement.
In acute displaced scaphoid fractures, it is the proximal fragment that displaces and should be reduced.
The typical "humpback" deformity is actually a "proximal extension" deformity, the consequence of displacement of the proximal fragment of the scaphoid (with the lunate). Manipulating only the proximal fragment (with the lunate) may be technically easier and more effective than manipulating both fragments.
我们的目标是在一个共同的坐标系中分析急性舟状骨腰部骨折碎片及相邻骨骼的运动。我们的假设是舟状骨远端碎片屈曲并旋前，近端碎片伸展。
使用三维（3D）模型对诊断为急性舟状骨腰部骨折患者的计算机断层扫描（CT）进行评估。将57例无移位骨折和23例移位骨折的扫描结果与27例显示腕部无病理病变的对照组扫描结果进行比较。在舟状骨、月骨和大多角骨的远端和近端碎片上标记三个解剖标志。每组标记形成代表骨骼或碎片的三角形。在桡骨远端关节面上标记四个标志，并用于创建一个共同的坐标系。参照这些坐标计算每块骨骼或碎片的位置。
与其他组相比，移位骨折组舟状骨近端碎片有明显的伸展、旋后和掌侧移位。月骨倾向于旋后位置，但无统计学意义。舟状骨远端碎片和大多角骨无移位。
在急性移位舟状骨骨折中，移位的是近端碎片，应予以复位。
典型的“驼背”畸形实际上是一种“近端伸展”畸形，是舟状骨近端碎片（与月骨一起）移位的结果。仅对近端碎片（与月骨一起）进行手法操作在技术上可能比同时操作两块碎片更容易、更有效。
