骨条植骨固定加桡骨茎突切除治疗腕舟骨骨不连

目的:报道应用骨条植骨固定加桡骨茎突切除术治疗腕舟骨骨不连的临床应用效果。方法:用桡骨近端骨条植骨固定腕舟骨骨折并切除桡骨茎突治疗腕舟骨骨不连23例。结果:23例全部获得随访,随访时间1～2年,骨性愈合率100％,愈合时间2～3个月,腕关节功能恢复正常。结论:该手术方法操作简便,损伤小,疗效好,是治疗腕舟骨骨不连的有效方法。     

带第1,2伸肌室间支持带上动脉蒂桡骨瓣治疗腕舟骨骨不连

目的 探讨治疗腕舟骨骨不连的有效手术方法。方法 对12侧新鲜成人上肢标本进行应用解剖研究后，设计出带第1，2伸肌室间支持带上动脉蒂桡骨瓣逆行移植的手术方法。自1997年以来，临床应用该方法治疗23例腕舟骨骨不连。结果 术后全部患者获得随访，随访时间为6个月～3年，骨性愈合率达100％，愈合时间为3～7个月，腕关节功能优良率达95．7％。结论 该术式操作简单、创伤小、疗效满意，为治疗腕舟骨骨不连的有效手术方法。     

腕舟骨陈旧性骨折骨不连的治疗

目的 探索治疗腕舟骨陈旧性骨折骨不连的有效方法.方法 在显微解剖学研究的基础上,设计出带桡动脉茎突返支的筋膜骨膜瓣转移及植骨的手术方法.结果 术后18例获得3～5年随访,骨性愈合率达到100%,愈合时间2～3个月,腕关节功能几乎完全恢复正常.结论 该手术方法疗效好、副损伤小、操作简单、易于推广,为治疗腕舟骨陈旧性骨折骨不连的有效方法之一.     

掌侧入路带桡动脉茎突返支骨瓣移植治疗腕舟骨骨不连

目的探讨掌侧入路带桡动脉茎突返支骨瓣移植治疗腕舟骨骨不连的方法及临床疗效。方法自2004年1月～2011年2月期间,采用掌侧入路带桡动脉茎突返支骨瓣移植联合克氏针内固定术治疗腕舟骨骨不连患者27例,回顾性分析其临床效果。结果本组26例术后获随访,平均随访时间18(6～25)个月。伤口均Ⅰ期愈合,X线检查提示26例腕舟骨术后平均3.2(3～4)个月获骨性愈合。术后腕关节功能按Krimmer评分:优20例,良4例,满意2例,优良率92.3%。结论掌侧入路带桡动脉茎突返支骨瓣移植克氏针内固定术治疗腕舟骨骨不连,可重建腕舟骨骨折端血运,促进骨折愈合,疗效肯定,该手术入路显露术野充分,便于手术操作,微创美观,值得临床推广。     

第一、二伸肌室间支持带上动脉为血管蒂的楔形骨瓣转移治疗舟骨骨不连

目的 探讨以第1,2伸肌室间支持带上动脉(1,2 ICSRA)为血管蒂的楔形骨瓣转移治疗舟骨骨不连伴背侧镶嵌不稳定(DISI)的技术和疗效.方法 对12例舟骨骨不连伴背侧镶嵌不稳定的患者,设计并应用1,2 ICSRA为血管蒂的楔形骨瓣进行治疗,采用腕背侧单一切口同时完成畸形矫正和骨瓣转移.术后随访骨折愈合时间、腕痛状况,比较手术前后腕关节活动度、握力、腕骨排列情况.结果 术后随访时间为6～24个月,平均12个月.X线片显示舟骨骨折均获得骨性愈合,愈合率为100%,平均愈合时间为11.3周.11例患者腕痛消失;1例腕痛持续,经行桡骨茎突切除后好转.12例术后头月骨间角、舟月骨间角、腕高指数恢复正常;腕关节屈伸、桡尺偏活动度接近术前的2倍,握力为术前的3.5倍.结论 1,2 ICSRA为血管蒂的楔形骨瓣转移能促进舟骨愈合,矫正骨折成角,有利于腕部生理力学的重建,是治疗舟骨骨不连伴DISI的有效方法.     

带蒂骨瓣转移治疗腕舟骨骨不连

目的：报告采用带蒂骨瓣转移治疗腕舟骨骨不连的疗效。方法：1995－2000年，对48例腕舟骨骨不愈合，采用带血管蒂、筋膜蒂及肌蒂移位治疗。石膏固定3个月，去石膏后辅以康复治疗。结果：随访7个月－5年，术后46例达骨性愈合，腕部疼痛、无力症状减轻或消失。功能按刘树清评定标准，优良率为95．8％。结论：带蒂骨瓣成骨作用强，能促进骨折愈合，适用于腕舟骨骨不连的治疗，是一种有效的治疗方法。     

带筋膜蒂骨瓣转移治疗腕舟骨骨不连分析

目的：探讨治疗腕舟骨陈旧性骨折骨不连的手术方法。方法：对16例腕舟骨陈旧性骨折骨不连采用带筋膜蒂逆行桡骨茎突骨瓣移植治疗的手术方法。结果：术后随访6－24个月，腕部疼痛及无力症状均消失，术后2－3月X线片示骨折均骨折愈合。结论：带筋膜蒂的桡骨茎突骨瓣移植治疗舟骨骨不连，操作简单，促进骨折愈率效果好。     

桡动脉腕背支掌骨瓣移植治疗腕舟骨陈旧性骨折骨不连接

目的：探讨治疗腕舟骨陈旧性骨折骨不连接的手术方法，方法：采用桡动脉腕背支掌骨瓣移植治疗腕舟骨陈旧性骨折骨不连接１３例。结果：随访３～２４个月，术后３个月骨折全部愈合，腕部疼痛、无力症状消失。结论：桡动脉腕背支位置表浅、变异少、血管蒂长，容易解剖，操作简便。带血管蒂骨瓣成骨作用强，能促进骨折愈合。     

以桡动脉返支为蒂的桡骨骨膜骨瓣移位治疗舟骨骨不连

目的　介绍带蒂桡骨骨膜骨瓣治疗腕舟骨骨不连的术式。方法　自 1986年 3月以来 ,选择 2 6例腕舟骨陈旧性骨折骨不连 ,设计并应用带蒂桡骨骨膜骨瓣移位植入 ,骨瓣为 1.0 cm× 0 .4cm× 0 .5 cm,术后观察其疗效。结果　 2 6例腕舟骨骨折骨不连患者切口均 期愈合 ,骨不连在术后 2～ 3个月内获得骨性愈合 ,腕关节功能基本恢复正常。结论　该术式是治疗腕舟骨骨折骨不连的一种有效方法     

带骨间前动脉蒂的桡骨瓣移植治疗腕舟骨骨不连骨坏死

目的探讨治疗腕舟骨骨不连骨坏死的手术方法.方法对13例腕舟骨骨不连、骨坏死的病人,采用以骨间前动脉背侧支为蒂的桡骨瓣逆行移植的手术方法治疗.结果术后临床随访3～28个月,腕部肿胀疼痛及无力症状均消失.13例在3～7个月内,X线片示骨折已全部骨性愈合及骨密度趋向正常.结论以骨间前动脉背侧支为蒂的桡骨瓣逆行移植治疗腕舟骨骨不连骨坏死,具有血管解剖恒定、手术操作简单,术后疗效确切的优点,是值得推广的一种手术方法.     

The progress in the classification and treatment of scaphoid nonunion

Scaphoid fracture is the most common carpal fracture, accounting for 50%–80% of all carpal fractures in the Youngers and manual workers. The nonunion rate of scaphoid fractures was approximately 10–15%. Scaphoid nonunion can lead to wrist deformity, wrist collapse, ischemic necrosis, and traumatic osteoarthritis resulting in the loss of wrist function and seriously influence the patients’ lives. Achieving bony union is essential for the treatment of scaphoid nonunion. Although many surgical procedures including various forms of bone grafting have been developed to improve bony union, there is no conclusion about which method is the most effective and optimal. In this review, we provide an overview of the diagnostic, classification and progress in the treatments of scaphoid nonunion fractures.     

经皮自体骨髓移植治疗骨折不愈合

目的 探讨经皮自体骨髓移植治疗骨折不愈合的疗效。方法 治疗患者３１例,男２５例,女６例;年龄１８￣７７岁,平均２７岁。骨不连部位：肱骨７例,腕舟骨１２例,股骨５例,胫骨７例。骨不连时间７￣４８个月,平均１３个月。治疗方法：在Ｘ线电视透视下将一枚骨穿针准确穿入骨不连部位,然后抽取自体髂骨红骨髓即刻注入骨不连部位。腕舟骨注射１０￣１５ｍｌ,一次即可;四肢长骨注射３０￣５０ｍｌ,需２￣３次,间隔３￣４周     

Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium

We have investigated whether assessment of blood flow to the proximal scaphoid can be used to predict nonunion in acute fractures of the scaphoid. We studied 32 fractures of the scaphoid one to two weeks after injury, by dynamic fat-suppressed T1-weighted gradient-echo MRI after the intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg body-weight). Steepest slope values (SSV) and percentage enhancement values (%E) were calculated for the distal and proximal fragments and poles. All the fractures were treated by immobilisation in a cast, and union was assessed by CT at 12 weeks. Nonunion occurred in four fractures (12%), and there was no statistically significant difference between the proximal fragment SSV and %E values for the fractures which united and those with nonunion. The difference between the proximal pole SSV and %E values for the union and nonunion groups reached statistical significance (p < 0.05), but with higher enhancement parameters for the nonunion group. Our results suggest that poor proximal vascularity is not an important determinant of union in fractures of the scaphoid.     

Displaced scaphoid waist fractures: the use of a week 4 CT scan to predict the likelihood of union with nonoperative treatment

This study assessed whether nonunion of displaced scaphoid waist fractures with nonoperative treatment could be predicted from 4 week CT scans. Thirty-one patients with unilateral displaced scaphoid waist fractures and adequate follow-up were included. CT scans in the longitudinal axis of the scaphoid with sagittal and coronal slices were done 4 weeks after the index injury. The effects of fracture gap, sclerosis and bone resorption on union were assessed. Fracture union was observed in all 13 displaced fractures with a < 2 mm gap, four of the seven with a gap of 2-3 mm and only four of the 11 with a gap > 3 mm (p = 0.01). Bone resorption involving more than 50% of the fracture cross-section was also associated with nonunion, but sclerosis was not.     

Treatment of Delayed/Nonunion of Scaphoid Waist with Synthes Cannulated Scaphoid Screw and Bone Graft

Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. Our aim was to conduct a retrospective study looking at the union rate, time to union, and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. This study is a review of a cohort of 30 patients treated with a cannulated Synthes scaphoid screw and corticocancellous bone grafting for scaphoid waist delayed union and nonunion at our center. We achieved 86% overall union rate. The patients with delayed union achieved a 100% union rate. Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting. No support of any kind was received from anybody.     

Percutaneous fixation of scaphoid fractures

Recent advances in techniques and implants have led to renewed interest in percutaneous screw fixation of acute scaphoid fractures. The closed (cast) treatment of acute scaphoid fractures generally has good outcome, with bony union resulting; however, closed treatment can result in delayed union, nonunion, malunion, cast- induced joint stiffness, and lost time from employment and avocations. Acute percutaneous fixation of scaphoid fracture has been proposed as a means to minimize some of the complications of closed (cast) treatment. Percutaneous treatment of both nondisplaced and displaced scaphoid fractures reportedly can achieve a nearly 100% union rate with minimal complications. Fixation of scaphoid fractures with headless compression screws can be done using both volar and dorsal approaches. The fracture reduction and alignment are assessed by fluoroscopy and arthroscopy. Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture.     

Cannulated variable pitch compression screw fixation of scaphoid fractures using a limited dorsal approach

Scaphoid fractures are common in the young, active patient. Treatment is challenging because of the complex three-dimensional anatomy of the scaphoid and the tenuous blood supply. Traditionally, cast immobilization has been used for the management of non-displaced fractures with satisfactory outcomes reported in the literature. However, non-surgical treatment may result in a delayed union or nonunion particularly if the fracture is unstable, displaced, or involves the proximal pole. Recently there has been increased interest in the fixation of non-displaced scaphoid fractures. The proposed advantages for operative treatment include avoiding the morbidity and inconvenience of prolonged cast immobilization and a lower incidence of delayed union or nonunion. A variety of surgical approaches for fixation of an acute scaphoid fracture have been described. The most common techniques include percutaneous fixation, arthroscopically assisted reduction and fixation, or open reduction and internal fixation via a volar approach. The senior author favors a limited dorsal approach with compression screw fixation of all proximal pole fractures as well as displaced and non-displaced fractures of the waist region. The technique is simple permitting accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union.     

Shoulder hemiarthroplasty for fractures of the proximal humerus

Scaphoid fractures are uncommon in children, but if maltreated, they can result in nonunion. The authors report a case of left scaphoid nonunion in an 11-year-old boy. The operative management of this pseudarthrosis was performed (K-wire fixation and bone grafting of scaphoid). After a 10-month follow-up period, the left wrist regained a full range of motion with no impairment. The roentgenograms showed union of the scaphoid. Surgical management of scaphoid nonunion fractures in children offers successful fusion, with very low nonunion rate and patient’s satisfaction.     

经皮腕掌侧入路Herbert螺钉内固定治疗非移位性舟骨骨折

目的：总结经皮腕掌侧入路Herbert螺钉内固定治疗舟骨骨折的经验。方法：自2008年4月至2012年9月,采用经皮腕掌侧入路Herbert螺钉内固定治疗舟骨骨折15例,男14例,女1例;年龄25～45岁,平均35岁;左侧10例,右侧5例。患者自受伤至就诊时间3～10 d,平均5 d.术前均行常规X线及CT检查,所有舟骨骨折提示均为B2型骨折（Herbert分型）.根据腕关节功能Krimmer评分标准对所有患者术后腕关节功能恢复情况进行评价。结果：15例患者获随访,时间5～18个月,平均10个月。术后3个月内每月复查X线1次,骨折愈合时间7～14周,平均10周,螺钉位置良好。术后参考Krimmer评分标准进行腕关节功能评定,14例为100分,1例90分。所有患者腕掌小切口Ⅰ期愈合,无感染和骨不愈合等并发症发生。结论：经皮腕掌侧入路Herbert螺钉内固定治疗舟骨骨折是一种微创、骨折愈合率高、并发症相对较少的有效治疗方法。     

Incidence, mechanism, and natural history of scaphoid fractures.

Scaphoid fractures are fairly common and remain a difficult problem with respect to diagnosis, treatment, and outcome. The initial goal is accurate diagnosis of the fracture using clinical evaluation and available imaging modalities. Union is the subsequent objective, with a trend toward restoration of normal scaphoid anatomy, because nonunion or malunion may lead to unacceptable results and patient dissatisfaction. Despite biomechanical research of simulated fractures and clinical studies on natural history, the exact outcome after scaphoid union, nonunion, and malunion remains variable.