一、 舟狀骨骨折(Scaphoid bone Fracture) ：50%的腕骨骨折都是Scaphoid bone Fracture，舟狀骨骨折，是常見的腕骨傷害，常被誤診為扭傷而延遲治療時機，而造成舟狀骨不癒合或壞死及腕部關節炎。舟狀骨表面大部分是軟骨，只有一條血管從遠端供應，一旦骨折導致血管供應中斷，近端骨折碎片非常容易壞死。舟狀骨骨折分類，一種是以解剖位置分類，a. Distal pole(20%) b. waist pole(70%) c. Proximal pole(10%) 的骨性構造命名， 而其中以waist pole(70%)發生率最高，其中以以waist pole(70%)部位骨折最常見。另一種分類則是以骨折穩定性為分類，穩定性骨折主要定義為未移位且未變形之骨折，不穩定性骨折則指已移位且變形之骨折例如骨折間隙大於十五度，舟狀骨近端骨折，粉碎性骨折、垂直斜位骨折等。不穩定性骨折若未及時正確診斷和手術治療，很可能造成不癒合或壞死。
1.診斷：X光檢查必須包括正面、側面和斜面三個方向以確認有無不癒合或壞死。可作骨骼掃描或MRI檢查，以查出有無不癒合或壞死。
2.治療：若舟狀骨骨折而未癒合則可作骨移植(Bone grafting)及內固定。若產生舟狀骨壞死則則施以腕骨間固定術(intercarpal arthrodesis)、近端排腕骨切除術(proximal row carpectomy)、腕關節固定術(wrist fusion)等。
資料來源：afa-sport
資料來源：eorthopod
舟狀骨骨折(Scaphoid bone
Fracture)
|
|
骨折情況
|
如何處理
|
沒有位移(non-displaced)
|
石膏固定約3個月
|
急性位移(Acute-displaced)
|
切開復位內固定(ORIF)
|
延遲癒合(delayed
union)
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切開復位內固定(ORIF)+骨頭移植(bone
graft)
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不癒合(nonunion)
|
切開復位內固定(ORIF)+骨頭移植(bone
graft)
|
近端處(small
proximal)
|
用Herbert screw(註) 從 dorsal
端固定
|
血液供應差(Poor
vascularity)
|
移植別處骨頭時，連帶血管一起移植
|
Herbert screw
資料來源：indiamart
二、月狀骨骨折(Lunate Fracture)
1. 月狀骨骨折占腕部骨折約3%
2. 併發症:
a. 骨性壞死(osteonecrosis)
b. Kienbock’s disease(註) 3. 依據X光的顯像，可分為四個stage Stage Ⅰ：急性期有黑色線 Stage Ⅱ：月狀骨硬化 Stage Ⅲ：月狀骨塌陷 Stage Ⅳ：全腕關節疾病
3.月骨壞死(Kienbock’s Disease)：因為月狀骨的供血缺少導致。
資料來源：eorthopod
症狀
a手腕腫脹
b漸進式手腕疼痛 主要原因反覆性壓迫力量發生在月狀骨上面，而引起重覆顯微骨折，日久後，即造成月狀骨的缺血性壞死及塌陷。如果有尺骨太短，更加劇此種情況。 治療則依時期不同而定。 第一、二期：可作尺骨延長術，或橈骨縮短術以減輕壓迫性力 第三、四期：可作月狀骨切除合併軟組織填塞、腕關節固定術等方法。
三、 鉤狀骨(hook of Hamate)骨折：用x-ray特殊照法: carpal tunnel view
說明: 用繃帶將伸直的指頭往後折(成垂直)，底片放在手下面，X光射線從手掌前方約45度處照射設置底片處。 有位移: 開刀 沒位移: 保守療法(固定)
carpal tunnel view
資料來源：chiromt
▼骨骼各論(skeletal monograph)
顯示/隱藏(show/hide)
標籤：
骨骼(skeleton)
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