手舟骨骨折課件

手舟骨骨折手舟骨骨折手舟骨解剖特點(diǎn)手舟骨骨折英文名“Scaphoid”起源于希臘詞匯“skaphos”，意思為“小船”，將其翻譯為“舟狀骨”或又稱之為“手舟骨”。手舟骨骨折與橈骨、月骨、頭骨、大多角骨相關(guān)聯(lián)；表面為透明軟骨覆蓋；血供較少，缺乏骨膜：1.骨折一期愈合，難以形成骨痂。2.背側(cè)支橈動(dòng)脈分支提供70%-80%血供，主要包含近極；掌側(cè)支提供20%-30%血供，主要包含遠(yuǎn)極。手舟骨骨折發(fā)病機(jī)制

跌倒時(shí)腕部撐地腰部70%-80%，近極10%-20%，遠(yuǎn)極及舟狀骨結(jié)節(jié)占5%兒童骨折多以遠(yuǎn)極為多手舟骨骨折TypeA(acutestablefractures)A1:fracturesofthetubercleA2:undisplaced“crack”fractureofwaistTypeB(acuteunstablefractures)Bl:obliquefracturesofdistalthirdB2:displacedormobilefracturesofwaistB3:proximalpolefracturesB4:fracturedislocationsofcarpusB5:comminutedfracturesTypeC(delayedunion)TypeD(establishednon-union)Dl:fibrousnon-unionD2:pseudarthrosisD3:ScleroticpseudarthrosisD4:AvascularNecrosis骨折分型手舟骨骨折病史及體格檢查外傷史，跌倒時(shí)手撐地

腕關(guān)節(jié)橈側(cè)腫脹、疼痛，活動(dòng)受限，尤其為背伸活動(dòng)受限鼻煙窩壓痛舟狀骨遠(yuǎn)端結(jié)節(jié)壓痛舟骨擠壓實(shí)驗(yàn)（+）手舟骨骨折輔助檢查

蝶側(cè)位X片

不穩(wěn)定骨折的診斷標(biāo)準(zhǔn)：1.移位超過(guò)1mm2.成角大于10°3.粉碎性4.橈月角大于15°5.舟月角大于60°6.舟骨內(nèi)角大于35°手舟骨骨折輔助檢查

腕關(guān)節(jié)CT：評(píng)估骨折程度及不易發(fā)現(xiàn)的骨折。腕關(guān)節(jié)MRI：用于診斷隱匿性骨折，結(jié)合造影劑用于判斷血供及有無(wú)缺血壞死的發(fā)生。手舟骨骨折鑒別診斷

舟月?lián)p傷腕關(guān)節(jié)扭傷腕關(guān)節(jié)軟組織挫傷其他腕骨骨折橈骨遠(yuǎn)端骨折手舟骨骨折治療

非手術(shù)治療---石膏固定手術(shù)治療---切開(kāi)復(fù)位內(nèi)固定

閉合復(fù)位內(nèi)固定

關(guān)節(jié)鏡輔助下內(nèi)固定

手舟骨骨折StevenJRhemrev,DaanOotes,FrankJPBeeres,SvenAGMeylaerts,IngerBSchipper.Rhemrevetal.InternationalJournalofEmergencyMedicine2011,4:4手舟骨骨折治療

非手術(shù)治療---石膏固定

適應(yīng)癥：急性、遠(yuǎn)極無(wú)位移（無(wú)位移腰部骨折仍存爭(zhēng)議）

通常固定時(shí)間為6-12周，根據(jù)復(fù)查情況而定

Colles’-typecastwiththewristinslightextensionJ.E.Hambidge,V.V.Desai,P.J.Schranz,J.P.Compson,T.R.C.Davis,N.J.Barton.TREATMENTBYCASTIMMOBILISATIONWITHTHEWRISTINFLEXIONOREXTENSION?JBoneJointSurg[Br]1999;81-B:91-2.手舟骨骨折治療手術(shù)治療---斷端加壓螺釘固定

閉合OR切開(kāi)OR其他？

手舟骨骨折切開(kāi)復(fù)位內(nèi)固定手舟骨骨折

切開(kāi)復(fù)位內(nèi)固定

431patients,Scaphoidfracture,ORIF,

overa13-yearperiodbyT.J.HERBERTS.L.FILAN,T.J.HERBERTHERBERTSCREWFIXATIONOFSCAPHOIDFRACTURESJBoneJointSurg[Br]1996;78-B:519-29.手舟骨骨折TableIII.Rateofunionrelatedtotypeoffractureforpatientswithatleast6months’follow-upFracturetypeUnionNonunion%UnionDistalobliqueB19190WaistB229488ProximalpoleB311285FibrousunionD165988PseudarthrosisD2733766ScleroticD3252550pseudarthrosisS.L.FILAN,T.J.HERBERTHERBERTSCREWFIXATIONOFSCAPHOIDFRACTURESJBoneJointSurg[Br]1996;78-B:519-29.手舟骨骨折閉合復(fù)位內(nèi)固定40patients,Scaphoidfracture,A1，B1，B2，semi-closedmethodofHerbertscrewfixation

G.INOUE,K.SHIONOYA.HERBERTSCREWFIXATIONBYLIMITEDACCESSFORACUTEFRACTURESOFTHESCAPHOIDJBoneJointSurg[Br]1997;79-B:418-21.手舟骨骨折閉合復(fù)位內(nèi)固定ConservativeSurgicalScaphoidunion38of3940of40Meantimeforunion(weeks)9.7±4.0*6±2.1Meantimeforunionintype-Bfracture(weeks)12.2±4.6?6.5±2.4Meantimetoreturntomanualwork(weeks)10.2±3.9*5.8±2.2*p<0.001?p<0.0001G.INOUE,K.SHIONOYA.HERBERTSCREWFIXATIONBYLIMITEDACCESSFORACUTEFRACTURESOFTHESCAPHOIDJBoneJointSurg[Br]1997;79-B:418-21.手舟骨骨折閉合復(fù)位內(nèi)固定32patients,Scaphoidfracture,B1,B2andCtypes，percutaneousfixationofscaphoidfracturesviaadorsalapproach手舟骨骨折閉合復(fù)位內(nèi)固定Allfracturesunitedoveranaverageofnineweeks.Therewasno

avascularnecrosisSameerNaranje&P.P.Kotwal&P.Shamshery&VikasGupta&H.L.Nag.Percutaneousfixationofselectedscaphoidfracturesbydorsalapproach.InternationalOrthopaedics(SICOT)(2010)34:997–1003手舟骨骨折關(guān)節(jié)鏡輔助下內(nèi)固定234scaphoidfracturesandnonunions126acuteinjuries;65proximalpolefractures;67grosslydisplacedfractures;12trans-scaphoidperilunatedislocationsincludingfourtrans-scaphoidtrans-capitatefractures;10combinedscaphoidanddistalradiusfractures.99%unionratebyCTscanin12weeksArthroscopywiththedorsalpercutaneousimplantationofaheadlesscompressionscrewSladeJF3rd,GillonT.Retrospectivereviewof234sca