Inoue G, Sakuma M
Department of Orthopaedic Surgery, Nagoya University Branch Hospital, Japan.
Arch Orthop Trauma Surg. 1996;115(1):1-4. doi: 10.1007/BF00453208.
A retrospective radiographic and clinical analysis of 102 symptomatic patients with 104 scaphoid nonunions of at least 1 year's duration was conducted. Osteoarthritis occurred in 22% of non-unions of less than 5 years' duration, 75% of those of 5 to 9 years' duration, and 100% of those of 10 years' duration or more. An all-over incidence of osteoarthritis in the wrist was 55%. Osteoarthritic changes occurred initially at the scaphoid-radial styloid joint which were manifested by radial styloid pointing and/or dorsal radioscaphoid osteophyte formation, later progressing to the midcarpal joint. Osteoarthritis at the scaphoid-radial styloid joint was significantly associated with dorsiflexed intercalated segment instability (DISI) deformity. An overall incidence of DISI deformity of the wrist was 56%, and the frequency of DISI pattern increased with longer duration of non-union. There was an increased incidence of avascular necrosis of the proximal fragment with time, especially after 20 years. There was no correlation between symptoms of pain and the severity of arthritis or the duration of non-union, but a good correlation between the duration of non-union and reduced grip strength or decreased wrist motion. A symptomatic non-union of the scaphoid is significantly likely to progress to osteoarthritis according to a predictable sequence, becoming worse both radiographically and clinically with time.
对102例有症状的舟骨不愈合患者（共104处，病程至少1年）进行了回顾性影像学和临床分析。病程小于5年的不愈合中，骨关节炎发生率为22%；病程5至9年的，发生率为75%；病程10年及以上的，发生率为100%。腕关节骨关节炎的总体发生率为55%。骨关节炎改变最初出现在舟骨-桡骨茎突关节，表现为桡骨茎突指向和/或背侧桡舟骨骨赘形成，随后发展至腕中关节。舟骨-桡骨茎突关节的骨关节炎与背伸型插入节段不稳定（DISI）畸形显著相关。腕关节DISI畸形的总体发生率为56%，且DISI模式的频率随不愈合时间延长而增加。近端骨折块的缺血性坏死发生率随时间增加，尤其是20年后。疼痛症状与关节炎严重程度或不愈合病程之间无相关性，但不愈合病程与握力下降或腕关节活动度降低之间存在良好相关性。有症状的舟骨不愈合很可能按照可预测的顺序发展为骨关节炎，随着时间推移，影像学和临床症状都会恶化。
