Scaphoid Fracture of the Wrist腕关节舟状骨骨折 A Patient’s Guide to Scaphoid Fracture of the Wrist腕关节舟状骨骨折患者指南 Introduction介绍 Doctors commonly diagnose a sprained wrist after a patient falls on an outstretched hand. However, if pain and swelling don’t go away, doctors become suspicious that the injury is actually more serious. A fall on an outstretched hand commonly breaks the scaphoid bone of the wrist. X-rays taken at the time of the injury may not clearly show the fracture. If the fracture is not recognized early, it may not heal properly. This can lead to problems later. 对于一个手背伸位摔倒的病人，医生通常的诊断都是腕关节扭伤。但是，如果腕关节的疼痛肿胀不能及时消退，医生会怀疑其实损伤没那么简单。手背伸位摔倒通常会导致腕舟骨骨折。受伤时的X线不一定能看清骨折。但是如果不能对腕舟骨骨折进行早期诊断，可能影响骨折愈合，甚至导致腕关节功能障碍。 This guide will help you understand · what causes fractures of the scaphoid bone · what nonunion of the scaphoid bone is · what you can do to treat each condition 这个指南将帮助你理解以下几个问题：
Anatomy解剖 Where is the scaphoid bone of the wrist? 腕舟骨的解剖位置在哪里？ The anatomy of the wrist joint is extremely complex, probably the most complex of all the joints in the body. The joint is actually a collection of many joints and many bones. These joints and bones let us use our hands in many ways. The wrist must be extremely mobile to give our hands a full range of motion. At the same time, the wrist must provide the strength for heavy gripping. 腕关节的解剖是相当复杂的，可以说是人体最复杂的关节。腕关节是很多个关节及骨头的集合。这些关节和骨头可以让我们的手做各种各样的动作。腕关节必须非常灵活以保证我们手的各角度全方位的活动。同时又得在抓重物时提供足够的力量。 The wrist is made up of eight separate small bones, called the carpal bones. The scaphoid bone is a carpal bone near the base of the thumb. The carpal bones connect the two bones of the forearm, the radius and the ulna, to the bones of the hand. The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb. 腕关节由8块小的独立的腕骨组成。腕舟骨是其中一块靠近拇指基底部的腕骨。腕骨连接前臂的尺桡骨和手骨。掌骨是位于手掌的长骨。掌骨与指骨相连，就是各手指和拇指的骨头。 One reason that the wrist is so complicated is because every small bone forms a joint with the bone next to it. This means that what we call the wrist joint is actually made up of many small joints. Ligaments connect all the small bones to each other, and to the radius, ulna, and metacarpal bones. 腕关节异常复杂的其中一个原因是每一块小骨都与周围的骨头形成关节。这就意味着我们所说的腕关节其实是由很多小关节组成的。各腕骨之间、腕骨与掌骨及腕骨与尺桡骨均通过韧带连接。 The scaphoid bone is a small carpal bone on the thumb side (radial side) of the wrist. It is the most commonly fractured carpal bone. This is probably because it actually crosses two rows of carpal bones, forming a hinge. A fall on the outstretched hand puts heavy stress on the scaphoid bone. This stress can cause either a small crack through the middle of the bone or a complete separation of the bone into two pieces. A separation is called a displaced fracture. 腕舟骨位于腕关节的拇指侧（即桡侧），是最常骨折的腕骨。可能是因为腕舟骨跨越两排腕骨，起着铰链的作用。当手在背身位摔倒时腕舟骨承受了巨大的压力。这个压力可能导致骨头中间发生一条裂缝甚至分成完全独立的两块（即移位性骨折）。 Related Document: A Patient’s Guide to Wrist Anatomy 相关阅读：腕关节解剖患者指南（翻译招募中，有意者请留言） Causes病因 What causes a scaphoid fracture? 腕舟骨骨折是怎么发生的? A scaphoid fracture is almost always caused by a fall on the outstretched hand. We commonly try to break a fall by putting our hands out for protection. Landing on an outstretched hand makes hand and wrist injuries, including a fracture of the scaphoid bone, fairly common. 腕舟骨骨折通常是在手背伸位摔倒时发生。我们通常试图用手撑地来应对摔倒，这是一种自我保护的机制。手背伸位着地可能导致我们手及腕关节受伤，包括相当常见的腕舟骨骨折。 When a scaphoid fracture is recognized on the first X-ray, treatment begins immediately. But patients often assume that the injury is just a sprain, and they wait for it to heal on its own. In some cases, the wrist gets better. In many cases the bone fails to heal. The scaphoid fracture then develops into what surgeons call a nonunion. 如果在第一次拍摄X线时就发现腕舟骨骨折，应该立刻开始治疗。但病人通常认为这只是一种扭伤，而且希望能自己愈合。有些时候腕关节恢复不错，但是很多时候骨折不能愈合，舟骨骨折于是就发展成为外科医生所说的骨不连。 A nonunion can occur in two ways. In a simple nonunion, the two pieces of bone fail to heal together. The second type of nonunion is much more serious. The lower half of the fractured bone loses its blood supply and actually dies. This condition is called avascular necrosis (Avascular means no blood supply, andnecrosis means dead.) 骨不连的发生有两种机制。一种简单情况是两个骨块没能长成一块。另一种情况则要复杂的多，骨折的近端骨折块血液供应缺失，导致缺血性骨坏死（缺血是指没有血液供应，坏死意味着死亡） The scaphoid bone is at risk for avascular necrosis. Only one small artery enters the bone, at the end that is closest to the thumb. If the fracture tears the artery, the blood supply is lost. Avascular necrosis becomes easy to see on X-rays several months after the injury. 腕舟骨骨折有缺血性骨坏死的风险。因为只有一条靠近拇指基底的小动脉供应。如果骨折损伤了这条动脉，那它的血液供应就没有了。缺血性坏死在骨折数月后的X线上会非常明显。 Symptoms症状 How will I know if I have a scaphoid fracture? 我怎么知道自己腕舟骨骨折了？ The symptoms of a fresh fracture of the scaphoid bone usually include pain in the wrist and tenderness in the area just below the thumb. You may also see swelling around the wrist. The swelling occurs because blood from the fractured bone fills the wrist joint. Thin people will see a bulging of the joint capsule. The joint capsule is the watertight sac that encloses the joint. 新鲜腕舟骨骨折的症状通常包括腕关节疼痛及拇指基底部区的压痛。同时，你有可能会发现腕关节周围肿胀。肿胀是由于骨折端出血充满腕关节腔导致的。瘦的人可能会看到凸出的关节囊。关节囊是指包绕关节的不透水的囊。 Symptoms of a nonunion of the scaphoid bone are more subtle. You may have pain when you use your wrist. However, the pain may be very minimal. It is fairly common for doctors to see a nonunion of the scaphoid bone on X-rays, but the patient can’t remember an injury. These people probably suffered a wrist injury years ago that they thought was a simple sprain. Still, the most common symptom of a nonunion is a gradual increase in pain. Over several years the nonunion can lead to degenerative arthritis in the wrist joint. 腕舟骨骨不连的症状相对更隐秘。你可能会在使用腕关节时感觉疼痛。但是，这种疼痛可能很轻微。很多时候医生通过X线发现了腕舟骨骨不连，但是患者可能不记得自己什么时候受过伤。这些患者可能很多年前腕关节受过伤，当时以为是简单的扭伤。骨不连最常见的症状是疼痛逐渐加重。几年后骨不连可能导致腕关节退变性关节炎。 Diagnosis诊断 What tests will my doctor run? 医生需要做那些测试？ Your doctor will first take a medical history. You will be asked questions about your pain and about any injuries to your wrist. Your doctor will also do a physical exam. The prodding and moving may hurt your wrist a bit. But it is important that your doctor know exactly where your pain is coming from. 首先你的医生会了解一下你的病史。你会被问及关于你腕关节疼痛及受伤的情况。同时也做一些物理检查。这些检查可能会导致你腕关节疼痛。但是这对于你的医生判断疼痛的来源非常重要。 Doctors should assume that any patient who has fallen on an outstretched hand and has swelling or tenderness on the thumb side of the wrist has a scaphoid fracture. You should assume this until tests prove otherwise. X-rays taken immediately after the injury may not show a fracture. Still, most surgeons will put a cast on the wrist and get another X-ray in 10 days. This gives the edges of the fractured bone time to heal, and may prevent nonunion. By waiting 10 days, the fracture is easier to see on an X-ray. 对于每一个腕背伸位摔倒的伴有拇指侧腕关节肿胀及压痛的病人，医生都应该怀疑腕舟骨骨折，直到检查明确排除。伤后即刻的X线或许不能显示骨折。但是大多数外科医生仍然会进行腕关节石膏固定，10天之后再行X线检查。这能让骨折边缘愈合，避免骨不连。10天的等待能让骨折线在X线上显示更清楚。 If it is still not clear whether or not you have a fracture, your doctor may order other imaging tests. You may have a bone scan done. A bone scan involves injecting tracers into your blood stream. The tracers then show up on special X-rays of your wrist. The tracers build up in areas of extra stress to bone tissue, such as a fracture. 如果仍然不能确定是否骨折，你的医生可能会要求做其它检查。你可以会行骨扫描检查。骨扫描时会向你的血液里注入示踪剂。这些示踪剂会在手腕的特殊X线上显示。这些示踪剂会在骨的某些区域浓聚，比如骨折部位。 Your doctor may also order a magnetic resonance imaging (MRI) scan. An MRI scan is a special imaging test that uses magnetic waves to create pictures of your body in slices. The MRI scan shows tendons as well as bones. It is painless and requires no needles or injections. 你的医生还可能会申请行磁共振检查。磁共振扫描是一种通过磁力扫描对身体进行分层成像的特殊检查。它能很好的显示骨和肌腱。而且是无痛的，不需要打针或注射。 Treatment治疗 Can a fracture or nonunion be healed? 骨折或骨不连能痊愈吗？ Nonsurgical Treatment非手术治疗 Fracture 骨折 If the fracture is identified immediately and is in good alignment, you will probably wear a cast for nine to 12 weeks. The cast will cover your forearm, wrist, and thumb. This is necessary to hold the scaphoid bone very still while it heals. Your doctor will take X-rays at least once a month to check the progress of the healing. Once your doctor is sure the fracture has healed, the cast will be removed. Even with this type of treatment, there is still a risk that the fracture may not heal well and will become a nonunion. 如果能及时发现骨折，而且骨折对位对线好，你可能需要石膏固定9-12周。石膏会包裹你的前臂、腕关节和大拇指。在腕舟骨的愈合过程中必须保持绝对稳定。你的医生可能会每月对你行一次X线检查，检查骨折的愈合情况。一旦确认骨折愈合良好，就可以拆除石膏了。即使这样治疗，也存在骨折愈合欠佳甚至发生骨不连的风险。 Nonunion 骨不连 A fracture that doesn’t heal within several months is considered a nonunion. If the injury is fairly recent, your doctor might recommend more time in the cast. He or she might also prescribe an electrical stimulator. The electrical stimulator is a device that sends a small electrical current to your scaphoid bone. You wear it like a large bracelet for 10 to 12 hours a day. Electrical current has been shown to help the bones heal. 骨折如果多月不能愈合就考虑骨不连可能。如果受伤时间尚短，你的医生可能会建议延长石膏固定时间。可能同时进行电刺激治疗。电刺激治疗是向腕舟骨释放小剂量的电流。你可能会每天戴一个类似手镯的东西10-12小时。电流被证明能促进骨折愈合。 Surgery手术 Screw Fixation 螺钉固定 Some surgeons report good results doing surgery right away when a patient has had a recent, nondisplaced scaphoid fracture. Studies have shown that this method can help people get back to activity faster than wearing a cast for up to 12 weeks. The procedure involves inserting a screw through the scaphoid. The screw holds the scaphoid firmly until it heals. 有些外科医生报道对行新鲜、无移位的腕舟骨骨折立即行手术治疗效果好。报道指出相比石膏固定12周，手术治疗能使患者更早的活动。手术需要贯穿腕舟骨置入螺钉。螺钉能维持腕舟骨的位置直到骨折愈合。 Scaphoid Debridement 腕舟骨清理术 In cases where a nonunion has occurred despite wearing a cast and using an electrical stimulator, surgery will likely be suggested. An incision is made in the wrist directly over the scaphoid bone. The surgeon finds the old fracture line on the scaphoid bone. All the scar tissue between the two halves of the bone must be removed (debrided). This creates a fresh bone surface to allow healing to begin again. In some cases, damaged bone tissue from the scaphoid is also removed. 如果通过石膏固定、电流刺激仍然发生了骨不连，那就只能建议行手术治疗。在腕舟骨正上方作切口，找到腕舟骨的陈旧性骨折线，清理骨折端所有疤痕组织，为骨折的愈合创造新鲜的骨面。有些情况腕舟骨的碎骨块也要被清理掉。 Bone Graft Method 骨移植术 Your surgeon may use a bone graft. A bone graft involves taking bone tissue from another spot in your wrist and inserting it into the fracture. A bone graft can stimulate healing on the surface of the bones. The bone graft is usually taken through a second small incision just above the wrist. (It is sometimes taken from the pelvis, through an incision in the side of your hip.) 外科医生可能会行骨移植。骨移植包括在腕关节的其它地方取些骨组织，然后放入骨折端。骨移植能耐刺激骨面之间的愈合。骨移植物通常通过另一个腕关节的小切口获取。（也有时候通过髋部的切口在骨盆处取骨。） After the bone graft is placed between the parts of the scaphoid bone, some surgeons also insert a metal pin or screw across the bone. The goal is to hold the two pieces of bone tightly together, allowing them to fuse into one bone. 骨移植后，有些外科医生还需要贯穿腕舟骨打入一枚金属针或一枚螺钉。希望使两个骨块牢固的结合在一起，融合成一块骨。 When the surgery is complete, the incision is stitched closed. The arm is placed in a large bandage or a splint. You are then awakened and taken to the recovery room. 手术结束后，缝合关闭切口。手臂用绷带包扎或夹板固定。然后你会苏醒并被送入恢复室。 Sometimes the bones still do not heal as planned. Surgeons call a fused bone that fails to heal a pseudarthrosis. If the nonunion continues to cause pain, you may need a second operation. Your surgeon will probably add more bone graft and check that the pins or screws are holding the bones together. 有些时候骨折仍不能愈合。外科医生把不能顺利愈合的骨融合称之为假关节形成。如果骨不连持续导致疼痛，你可能需要再次手术。外科医生可能会植入更多的骨组织，确保金属针或螺钉牢固固定骨块。 Rehabilitation康复 What will my recovery be like? 康复是怎样的一个过程？ Nonsurgical Rehabilitation非手术治疗的康复
If the bone is in good alignment, and there are no problems with the blood supply to the bone, you may be placed in a cast for nine to 12 weeks. Some doctors prefer to start with a long-arm cast. Others use a thumb-spica cast designed to keep the wrist and thumb from moving. 如果骨折对位对线好，而且骨的血液供应好，你可能需要石膏固定9-12周。有些医生喜欢长臂石膏固定，有些会用拇人字石膏仅限制腕关节和拇指的固定。 The amount of time you need to wear the cast depends on what part is fractured and whether the bones heal well. When your doctor is certain the bones have healed, your cast will be removed. Your wrist will probably be stiff and weak from being in the cast. You may need physical or occupational therapy to help improve wrist range of motion and strength. 石膏固定的具体时间需要看骨折的位置及骨折愈合的情况。当医生确定骨折愈合，你的石膏就可以拆除了。你的腕关节可能会因为石膏固定而感觉僵硬和无力。你可能需要物理治疗或职业治疗帮助提升腕关节活动度和力量。 After Surgery术后康复 Depending on the type of surgery you have, you may be placed in a splint for up to 12 weeks after surgery. Your surgeon will X-ray the wrist several times after surgery to make sure that the bones are healing properly. Once the two halves of the scaphoid bone have healed, you can safely begin a rehabilitation program. 根据你的手术方式，你可能需要术后夹板固定12周。外科医生可能会进行多次的X线检查，确保骨块愈合良好。一旦腕舟骨的两个骨折块愈合良好，你就可以放心的开始康复。 You may need physical or occupational therapy sessions for six to eight weeks after surgery. The first few treatments will focus on controlling the pain and swelling. You will work into doing exercises to help strengthen and stabilize the muscles around the wrist joint. Other exercises are used to improve fine motor control and dexterity of your hand. You’ll be given tips on ways to do your activities while avoiding extra strain on the wrist joint. 术后你可能需要物理治疗或职业治疗6-8周。最开始的治疗重点在于控制疼痛及肿胀。你会进行一些锻炼帮助提高腕关节的周围肌肉的强度及稳定性。另外一些锻炼会帮助提高你手的灵活性及精细活动能力。你会被指导如何更好的活动避免腕关节的扭伤。 （王伟斌 译）
王伟斌，男，33岁，硕士，毕业于浙江大学医学院，师从郑强教授，现为宁波市第二医院骨科主治医师。擅长骨科常见疾病的诊断和手术治疗。
（编辑：胡佰文） |
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