Cooney W P, Linscheid R L, Dobyns J H, Wood M B
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905.
J Hand Surg Am. 1988 Sep;13(5):635-50. doi: 10.1016/s0363-5023(88)80116-3.
Twenty-one cases of unstable fractures of the scaphoid were treated by open reduction, length restoration by interpositional anterior wedge grafting, and fixation with a Herbert screw to obtain union and restore carpal stability. There was primary union in 15 (71%) of 21 patients. Two failed cases were treated with a second anterior wedge graft and Herbert screw fixation; overall rate of union was 81%. Nonunions were related to improper screw placement, failure of compression at the nonunion, bone-graft resorption, or persistent avascular necrosis. In the united scaphoids, carpal instability was corrected, with improvement in the scapholunate angle (65 degrees to 54 degrees) and capitolunate angulations (35 degrees to 15 degrees). Scaphoid malalignment associated with nonunion was improved on biplanar tomographic measurement of the scaphoid angles.
21例舟骨不稳定骨折采用切开复位、经前路楔形植骨恢复长度并用Herbert螺钉固定的方法进行治疗，以实现骨折愈合并恢复腕关节稳定性。21例患者中有15例（71%）实现了一期愈合。2例失败病例接受了二次前路楔形植骨及Herbert螺钉固定治疗；总体愈合率为81%。骨不连与螺钉放置不当、骨不连处加压失败、骨移植吸收或持续性缺血性坏死有关。在愈合的舟骨中，腕关节不稳定得到纠正，舟月角（从65度改善至54度）和头月角（从35度改善至15度）有所改善。在舟骨角的双平面断层测量中，与骨不连相关的舟骨排列不齐情况得到改善。
