Monsivais J J, Nitz P A, Scully T J
J Hand Surg Br. 1986 Jun;11(2):201-6. doi: 10.1016/0266-7681(86)90260-3.
We studied twenty consecutive scaphoid nonunions in twenty patients between the ages of eighteen and thirty-eight years. There were nineteen males and one female. The mean age was 25.2 years. Factors evaluated were fracture displacement, delay in treatment, and carpal instability. Fracture displacement and carpal instability were documented in patients by abnormal x-rays showing fragment displacement, abnormal scapholunate and radiolunate angles, etc., or by fluoroscopically controlled arthrography. We concluded that intercarpal ligamentous instability is consistently present and, therefore, the critical factor in wrists with ununited scaphoid fractures. Thirteen patients have been treated surgically; ligamentous disruption was confirmed at surgical exploration. In twelve patients, treatment of the nonunion included intercarpal ligamentous reconstruction. A satisfactory outcome was achieved in all twelve of these patients. One patient's treatment did not include ligament reconstruction. Although the scaphoid fracture united after a Russe bone graft, he remains symptomatic with persistent intercarpal instability. The remaining seven patients are being evaluated or awaiting surgery. Since ligamentous injury is so common in nonunion, we believe it is causal and that surgical care of nonunion involves ligamentous repair or other stabilization procedure. Prevention of nonunion involves early attention to the therapy of carpal instability when associated with scaphoid fracture.
我们研究了20例年龄在18至38岁之间的舟状骨不愈合患者，均为连续病例。其中男性19例，女性1例。平均年龄为25.2岁。评估的因素包括骨折移位、治疗延迟和腕关节不稳定。骨折移位和腕关节不稳定通过异常X线片记录，显示骨折块移位、舟月角和桡月角异常等，或通过透视控制的关节造影。我们得出结论，腕骨间韧带不稳定始终存在，因此是舟状骨骨折不愈合腕关节的关键因素。13例患者接受了手术治疗；手术探查证实存在韧带断裂。在12例患者中，不愈合的治疗包括腕骨间韧带重建。所有这12例患者均取得了满意的疗效。1例患者的治疗未包括韧带重建。尽管在进行Russe植骨术后舟状骨骨折愈合，但他仍有症状，存在持续的腕骨间不稳定。其余7例患者正在接受评估或等待手术。由于韧带损伤在不愈合中非常常见，我们认为其具有因果关系，不愈合的手术治疗涉及韧带修复或其他稳定手术。预防不愈合包括在舟状骨骨折伴有腕关节不稳定时尽早关注其治疗。
