Mack G R, Bosse M J, Gelberman R H, Yu E
J Bone Joint Surg Am. 1984 Apr;66(4):504-9.
We reviewed the clinical and roentgenographic findings of forty-seven non-unions of a fracture of the scaphoid in forty-six symptomatic patients in order to assess the incidence and severity of degenerative changes of the wrist. The duration of non-union ranged from five to fifty-three years. Three roentgenographic patterns were seen: twenty-three lesions had sclerosis, cyst formation, or resorptive changes confined to the scaphoid bone (Group I); fourteen had radioscaphoid arthritis (Group II); and ten had generalized arthritis of the wrist (Group III). The duration of Group-I non-unions averaged 8.2 years; Group-II, 17.0 years; and Group-III non-unions, 31.6 years. Fracture displacement and carpal instability correlated with the severity of degenerative changes. Lunate dorsiflexion of 10 degrees or more was a useful guide to carpal instability. Few of the forty-seven non-unions were undisplaced, stable, or free of arthritis after ten years. Based on the high probability of arthritis, we recommend that all displaced ununited scaphoid fractures be reduced and grafted, regardless of symptoms, before degenerative changes occur. Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.
我们回顾了46例有症状患者的47例舟骨骨折不愈合的临床和X线表现，以评估腕关节退变改变的发生率和严重程度。骨折不愈合的时间为5至53年。观察到三种X线表现类型：23处病变有硬化、囊肿形成或仅限于舟骨的吸收性改变（I组）；14处有桡舟关节关节炎（II组）；10处有腕关节广泛性关节炎（III组）。I组骨折不愈合的平均时间为8.2年；II组为17.0年；III组骨折不愈合的平均时间为31.6年。骨折移位和腕骨不稳定与退变改变的严重程度相关。月骨背伸10度或以上是判断腕骨不稳定的有用指标。47例骨折不愈合患者中，很少有在10年后无移位、稳定或无关节炎的。基于发生关节炎的高可能性，我们建议在退变改变出现之前，所有移位的舟骨骨折不愈合均应进行复位和植骨，无论有无症状。对于无移位、稳定的骨折不愈合的无症状患者，应告知其后期发生退变改变的可能性。
