Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonu...Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.展开更多
目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型...目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型桡骨远端骨折同时合并Ⅱ型尺骨茎突基底骨折患者资料,男性32例,女性55例;年龄28~68岁,平均56.3岁;摔伤40例,高处坠落伤47例。根据尺骨茎突骨折是否固定分为固定组(46例)、对照组(41例),桡骨远端骨折均采用Henry入路切开复位掌侧锁定接骨板内固定,固定组行尺骨茎突切开复位克氏针张力带内固定,对照组给予前臂旋后位经皮自尺骨向桡骨克氏针间接固定。术后1d及1、3、12个月分别记录患者患肢功能参数(掌屈、背伸、旋前、旋后)、手指总主动活动度(total active motion,TAM)及视觉模拟评分(visual analogue scale,VAS),定期复查腕部X线片评估骨折愈合情况,记录骨折愈合时间。末次随访记录患肢腕尺侧疼痛发生率,关节功能评价使用Gartland-Werley功能评分、上肢功能(disability of arm,shoulder and hand,DASH)评分评定患肢功能。结果术后患者均获随访,随访时间13~26个月,平均16.4个月。两组桡骨远端骨折均达骨性愈合,骨折愈合时间比较差异无统计学意义。固定组尺骨茎突均骨性愈合,无畸形愈合或不愈合发生;对照组骨性愈合24例(其中畸形愈合14例),不愈合17例。术后1d、1个月,固定组患肢功能参数(掌屈、背伸、旋前、旋后)均明显优于对照组(P<0.05);术后3个月,固定组掌屈角度明显大于对照组(P<0.05),背伸角度及手指TAM比较差异无统计学意义;术后12个月,两组患者掌屈角度及手指TAM比较差异无统计学意义;术后所有时间节点旋后角度固定组均明显大于对照组(P<0.05);术后1d固定组VAS高于对照组,此后的时间节点固定组VAS均低于对照组,但差异无统计学意义(P>0.05);末次随访显示固定组尺侧旋转疼痛发生率(15.2%,7/46)明显低于对照组(51.2%,21/41,P<0.05),Gartland-Werley评分、DASH评分均优于对照组(P<0.05)。结论对于合并尺骨茎突基底骨折的C型桡骨远端骨折,尺骨茎突骨折切开复位内固定能够明显提高桡骨远端C型骨折术后腕关节功能,降低尺骨茎突畸形愈合、不愈合发生率。展开更多
文摘Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.
文摘目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型桡骨远端骨折同时合并Ⅱ型尺骨茎突基底骨折患者资料,男性32例,女性55例;年龄28~68岁,平均56.3岁;摔伤40例,高处坠落伤47例。根据尺骨茎突骨折是否固定分为固定组(46例)、对照组(41例),桡骨远端骨折均采用Henry入路切开复位掌侧锁定接骨板内固定,固定组行尺骨茎突切开复位克氏针张力带内固定,对照组给予前臂旋后位经皮自尺骨向桡骨克氏针间接固定。术后1d及1、3、12个月分别记录患者患肢功能参数(掌屈、背伸、旋前、旋后)、手指总主动活动度(total active motion,TAM)及视觉模拟评分(visual analogue scale,VAS),定期复查腕部X线片评估骨折愈合情况,记录骨折愈合时间。末次随访记录患肢腕尺侧疼痛发生率,关节功能评价使用Gartland-Werley功能评分、上肢功能(disability of arm,shoulder and hand,DASH)评分评定患肢功能。结果术后患者均获随访,随访时间13~26个月,平均16.4个月。两组桡骨远端骨折均达骨性愈合,骨折愈合时间比较差异无统计学意义。固定组尺骨茎突均骨性愈合,无畸形愈合或不愈合发生;对照组骨性愈合24例(其中畸形愈合14例),不愈合17例。术后1d、1个月,固定组患肢功能参数(掌屈、背伸、旋前、旋后)均明显优于对照组(P<0.05);术后3个月,固定组掌屈角度明显大于对照组(P<0.05),背伸角度及手指TAM比较差异无统计学意义;术后12个月,两组患者掌屈角度及手指TAM比较差异无统计学意义;术后所有时间节点旋后角度固定组均明显大于对照组(P<0.05);术后1d固定组VAS高于对照组,此后的时间节点固定组VAS均低于对照组,但差异无统计学意义(P>0.05);末次随访显示固定组尺侧旋转疼痛发生率(15.2%,7/46)明显低于对照组(51.2%,21/41,P<0.05),Gartland-Werley评分、DASH评分均优于对照组(P<0.05)。结论对于合并尺骨茎突基底骨折的C型桡骨远端骨折,尺骨茎突骨折切开复位内固定能够明显提高桡骨远端C型骨折术后腕关节功能,降低尺骨茎突畸形愈合、不愈合发生率。
