Luchetti Timothy J, Hedroug Youssef, Fernandez John J, Cohen Mark S, Wysocki Robert W
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Hand Surg Eur Vol. 2018 Jan;43(1):73-79. doi: 10.1177/1753193417739546. Epub 2017 Nov 6.
The purpose of this study was to measure the radiographic parameters of proximal pole scaphoid fractures, and calculate the ideal starting points and trajectories for antegrade screw insertion. Computed tomography scans of 19 consecutive patients with proximal pole fractures were studied using open source digital imaging and communications in medicine (DICOM) imaging measurement software. For scaphoid sagittal measurements, fracture inclination was measured with respect to the scaphoid axis. The ideal starting point for a screw in the proximal pole fragment was then identified on the scaphoid sagittal image that demonstrated the largest dimensions of the proximal pole, and hence the greatest screw thread purchase. Measurements were then taken for a standard screw trajectory in the axis of the scaphoid, and a trajectory that was perpendicular to the fracture line. The fracture inclination in the scaphoid sagittal plane was 25 (SD10) °, lying from proximal palmar to dorsal distal. The fracture inclination in the coronal plane was 9 (SD16) °, angling distal radial to proximal ulnar with reference to the coronal axis of the scaphoid. Using an ideal starting point that maximized the thread purchase in the proximal pole, we measured a maximum screw length of 20 (SD 2) mm when using a screw trajectory that was perpendicular to the fracture line. This was quite different from the same measurements taken in a trajectory in the axis of the scaphoid. We also identified a mean distance of approximately 10 mm from the dorsal fracture line to the ideal starting point. A precise understanding of this anatomy is critical when treating proximal pole scaphoid fractures surgically.
本研究的目的是测量舟骨近端骨折的影像学参数，并计算顺行螺钉置入的理想起始点和轨迹。使用开源的医学数字成像和通信（DICOM）成像测量软件，对19例连续的舟骨近端骨折患者的计算机断层扫描进行了研究。对于舟骨矢状面测量，相对于舟骨轴线测量骨折倾斜度。然后在显示舟骨近端最大尺寸（从而获得最大螺钉螺纹咬合）的舟骨矢状面上确定近端骨折块中螺钉的理想起始点。接着测量舟骨轴线上标准螺钉轨迹以及垂直于骨折线的轨迹。舟骨矢状面的骨折倾斜度为25（标准差10）°，从近端掌侧至背侧远端。冠状面的骨折倾斜度为9（标准差16）°，相对于舟骨冠状轴从桡侧远端向尺侧近端成角。使用使近端骨折块中螺纹咬合最大化的理想起始点，当使用垂直于骨折线的螺钉轨迹时，我们测量的最大螺钉长度为20（标准差2）mm。这与在舟骨轴线上的轨迹进行相同测量时的结果有很大不同。我们还确定从背侧骨折线到理想起始点的平均距离约为10毫米。在手术治疗舟骨近端骨折时，精确了解这种解剖结构至关重要。
