Yarar-Schlickewei S, Frosch K H, Schlickewei C
Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Unfallchirurg. 2019 Mar;122(3):191-199. doi: 10.1007/s00113-018-0596-2.
Nonunion of the scaphoid is a severe complication of often insufficiently treated scaphoid fractures or those which have been diagnosed too late. The treatment of scaphoid nonunion is challenging und should be performed by experienced hand surgeons. The anatomical shape, the retrograde blood supply and the biomechanics of the scaphoid complicate the healing process. A delayed union or nonunion of the fractured scaphoid leads to persistent pain, restricted mobility and degenerative changes of carpal bones and wrist. The goal of treatment is bony healing of the pseudarthrosis with reconstruction of the anatomical shape and restoration of the axial alignment of the scaphoid. A prerequisite is the right choice of the different treatment options available. Fundamental to this is a careful pretherapeutic assessment as well as an individual classification of the pathological alterations and the morphological features of the nonunion. For this purpose, radiological cross-sectional imaging by means of computed tomography is essential. There is no consensus in the literature about the treatment of scaphoid nonunion. The available data do not enable the establishment of a superior treatment procedure. The most common surgical procedure used to treat scaphoid nonunion is autologous bone grafting combined with screw fixation. This article provides an up to date overview of the management and standard procedures for the primary treatment of scaphoid nonunion without a circulatory disorder.
舟骨不愈合是舟骨骨折治疗常不充分或诊断过晚所导致的严重并发症。舟骨不愈合的治疗具有挑战性，应由经验丰富的手外科医生进行。舟骨的解剖形状、逆行血供及生物力学特性使愈合过程变得复杂。舟骨骨折延迟愈合或不愈合会导致持续疼痛、活动受限以及腕骨和腕关节的退行性改变。治疗的目标是使假关节实现骨性愈合，重建解剖形状并恢复舟骨的轴向对线。前提是正确选择现有的不同治疗方案。对此至关重要的是进行仔细的治疗前评估以及对不愈合的病理改变和形态特征进行个体化分类。为此，通过计算机断层扫描进行放射学横断面成像必不可少。关于舟骨不愈合的治疗，文献中尚无共识。现有数据无法确立一种更优的治疗方法。用于治疗舟骨不愈合最常用的外科手术是自体骨移植联合螺钉固定。本文提供了无血液循环障碍的舟骨不愈合一期治疗的管理及标准程序的最新概述。
