PDF(Pubmed)
Abstract：
BACKGROUND: Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw.
METHODS: Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.
RESULTS: Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.
CONCLUSIONS: Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.
METHODS: Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.
RESULTS: Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.
CONCLUSIONS: Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.
摘要：
背景：舟骨骨折是最常见的腕关节损伤，占所有腕骨骨折的80-90%。5-15%的舟骨骨折骨不连报告，即使有适当的初级治疗，几十年后可能会发展为骨关节炎的变化。关于舟骨体外和体内生理特性的研究以及临床实践中的各种试验正在进行中，这对我们的临床实践有很大贡献。随着腕关节镜的推进，3D打印针对患者的钻孔导向器,术中透视引导，背侧入路（微创和经皮技术）正在流行，通过它，我们可以植入螺钉，与生物力学很好地吻合，并且舟骨的血液供应不那么令人不安。研究不同腕部位置的背侧近端舟骨的非接触区域可以有助于术前估计螺钉的插入点。
方法：招募了8名志愿者，以6种极端的手腕体位接受CT扫描。将DICOM模式的图像输入模拟分析系统，分段的舟骨，lunate和radius以ASCIISTL模式导出，并在Geomagicstudio的软件中打开。我们基于半径和舟骨表面上的解剖标记创建了四个平面，以限制近端舟骨形成所谓的非接触区域。我们测量并比较了六个目标位置的区域。
结果：在六个极端的手腕位置中，在极端的背部延伸（59.81±26.46mm2）的非接触区域的面积显著最小，极掌屈曲时最大(170.51±30.44mm2)。非接触区域按背侧延伸的顺序增加，仰卧起坐,尺位偏差,径向偏差,前旋和手掌屈曲。至于两组比较，除个别内旋外，非接触区域的手掌屈曲明显大于其他区域（p<0.05），径向偏差（p<0.05）高于背侧延伸。
结论：尽管有腕部位置，但从背侧入路开始的螺钉仍有足够的空间。
方法：招募了8名志愿者，以6种极端的手腕体位接受CT扫描。将DICOM模式的图像输入模拟分析系统，分段的舟骨，lunate和radius以ASCIISTL模式导出，并在Geomagicstudio的软件中打开。我们基于半径和舟骨表面上的解剖标记创建了四个平面，以限制近端舟骨形成所谓的非接触区域。我们测量并比较了六个目标位置的区域。
结果：在六个极端的手腕位置中，在极端的背部延伸（59.81±26.46mm2）的非接触区域的面积显著最小，极掌屈曲时最大(170.51±30.44mm2)。非接触区域按背侧延伸的顺序增加，仰卧起坐,尺位偏差,径向偏差,前旋和手掌屈曲。至于两组比较，除个别内旋外，非接触区域的手掌屈曲明显大于其他区域（p<0.05），径向偏差（p<0.05）高于背侧延伸。
结论：尽管有腕部位置，但从背侧入路开始的螺钉仍有足够的空间。
