摘要目的 在体研究腕舟骨腰部骨折后屈-伸、桡-尺偏运动时的三维运动学变化,为临床诊治提供理论指导.方法 对10例腕舟骨腰部骨折成年志愿者的双侧腕关节,分别在中立位、掌屈及背伸各15°、30°、45°、60°,桡偏10°、20~及尺偏10°、20°、30°、40°位置进行螺旋CT成像扫描.在基于计算机的手术模拟系统中进行三维定量分析.在桡骨远端关节面的中心点建立三维直角坐标系统,测量腕舟骨骨折后远、近端骨块的三维运动学数据.并与健侧腕舟骨的测量数据进行比较分析.结果 腕舟骨骨折后,近端骨折块与健侧比较,旋转、位移改变不明显,远端骨折块则变化较大.腕关节桡偏10°、背伸30°时,远近端骨块质心间距离最小.结论 在舟骨腰部骨折的治疗中,腕关节取桡偏10°、背伸30°位置时,骨折断端间距离较小,复位满意,为舟骨骨折的治疗提供了一定的理论参考.

abstractsObjective To accurately quantify three-dimensional in vivo kinematics of fractured scaphoid in wrist flexion-extension and radial-ulrar deviation, and to provide the theoretic bases for clinical application. Methods The bilateral wrists of 10 adult volunteers with scaphoid fractures were imaged by spiral CT at neutral position, at 15°, 30°, 45° and 60° of wrist flexion-extension, at 10° and 20° of radial deviation and at 10°, 20°, 30° and 40° of ulnar deviation. The 3D quantitative measurement and analysis of fractured scaphoid were performed in our computer-operated simulation system. The 3D kinematic data of the proximal and distal fragments of the fractured scaphoid were measured using the center of articular surface of the distal radius as reference. The kinematic data from the healthy side scaphoid were also acquired for comparison. Results After the scaphoid was fractured, being compared with the normal scaphoid, the proximal fragment of the scaphoid did not show obvious changes of rotation and translation. The changes of the distal fragment of the scaphoid were significant. When the wrist was positioned at 10° radial deviation and 30° extension, the distance between the centroids of distal and proximal fragment models was the smallest. Conclusion In the treatment of scaphoid fractures, the wrist should be kept at 10° radial deviation and 30° extension to ensure shortest distance between the fracture fragments and hence satisfactoiy reduction. The study provided some theoretic and technical reference for treatment of scaphoid fractures.