Martini A K
Stiftung Orthopädische Klinik und Poliklinik der Universiät Heidelberg.
Orthopade. 1994 Jun;23(3):249-54.
Knowledge of the natural history of scaphoid nonunion is important for establishing the indication for surgery. The late results after the Matti-Russe operation reveal carpal arthrosis in a relatively high percentage of cases. On the other hand, we see patients who have engaged in sports and have continued working without symptoms for years despite scaphoid nonunion. We now address the question as to the nature and time of the development of arthrosis and the factors affecting it. Forty-one patients with pseudarthrosis were followed up over a period of 3-39 years. For comparison, 55 patients in whom a Matti-Russe operation had been successfully performed were followed up for the same period. Both the clinical and radiological appearance seem to be better in patients operated on than in those who were not operated on. The time factor, the location and the form of the fracture determine the development of arthrosis. No patient was free of arthrosis after 10 years. Arthrosis begins in the scaphostyloid joint and progresses to the scaphotrapezoid, scaphocapital and scapholunar joint. Development of midcarpal arthrosis takes place over about 20 years. Unstable and displaced fractures accelerate the development of arthrosis. Proximally located pseudarthroses are unfavorable because of the danger of osteonecrosis of the proximal fragment. These pseudarthroses should be eliminated as soon as possible by surgery.
了解舟骨不愈合的自然病程对于确定手术指征很重要。马蒂 - 鲁斯手术（Matti-Russe operation）后的晚期结果显示，相当高比例的病例出现腕关节病。另一方面，我们也看到一些患者尽管患有舟骨不愈合，但多年来一直从事体育活动且无症状地继续工作。我们现在探讨关节病的性质、发展时间以及影响它的因素。41例假关节患者接受了3至39年的随访。作为对照，55例成功接受马蒂 - 鲁斯手术的患者在同一时期接受了随访。接受手术的患者在临床和影像学表现上似乎都比未接受手术的患者更好。时间因素、骨折的位置和形态决定了关节病的发展。10年后没有患者没有关节病。关节病始于舟月关节，并发展至舟大多角骨、舟头状骨和舟月关节。腕中关节病的发展约需20年。不稳定和移位的骨折会加速关节病的发展。近端假关节由于近端骨折块发生骨坏死的风险而预后不佳。这些假关节应尽快通过手术消除。
