Trumble T E, Clarke T, Kreder H J
Department of Orthopaedics, University of Washington, Seattle 98195, USA.
J Bone Joint Surg Am. 1996 Dec;78(12):1829-37. doi: 10.2106/00004623-199612000-00005.
We retrospectively reviewed the results for thirty-four patients in whom a non-union of the scaphoid had been treated with bone-grafting and internal fixation with use of one of two types of screws as well as the temporary placement of Kirschner wires parallel to the screw to prevent rotation. The patients were divided into two groups: Group 1 contained sixteen patients who had been managed with a Herbert screw from 1986 through 1989 and Group 2, eighteen patients who had been managed with a 3.5-millimeter cannulated AO/ASIF screw from 1990 through 1992. There were no clinical or radiographic differences between the two groups. The time to union, confirmed with tomography, was 7.6 +/- 3.6 months for Group 1 and 3.6 +/- 1.2 months for Group 2. This difference was significant (p < 0.01). Both screws significantly improved the alignment of the scaphoid and decreased carpal collapse (p < 0.05). Regardless of the type of screw used, the time to union was significantly shorter when the screw had been placed in the central one-third of the scaphoid (p < 0.05). Seventeen of the eighteen cannulated screws had been placed centrally, compared with seven of the sixteen Herbert screws (p < 0.01).
我们回顾性分析了34例舟骨不愈合患者的治疗结果，这些患者均接受了植骨及内固定治疗，使用了两种类型的螺钉之一，并临时平行于螺钉放置克氏针以防止旋转。患者被分为两组：第1组包含16例患者，于1986年至1989年使用Herbert螺钉治疗；第2组包含18例患者，于1990年至1992年使用3.5毫米空心AO/ASIF螺钉治疗。两组之间在临床及影像学方面均无差异。经断层扫描确认，第1组的愈合时间为7.6±3.6个月，第2组为3.6±1.2个月。这一差异具有统计学意义（p<0.01）。两种螺钉均显著改善了舟骨的对线并减少了腕骨塌陷（p<0.05）。无论使用何种类型的螺钉，当螺钉置于舟骨中央三分之一处时，愈合时间均显著缩短（p<0.05）。18枚空心螺钉中有17枚置于中央，而16枚Herbert螺钉中只有7枚（p<0.01）。
