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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">genort</journal-id><journal-title-group><journal-title xml:lang="ru">Гений ортопедии</journal-title><trans-title-group xml:lang="en"><trans-title>Genij Ortopedii</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1028-4427</issn><issn pub-type="epub">2542-131X</issn><publisher><publisher-name>ЦЕНТР ИЛИЗАРОВА</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.18019/1028-4427-2025-31-1-91-100</article-id><article-id custom-type="elpub" pub-id-type="custom">genort-3168</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Обзор литературы</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Literature review</subject></subj-group></article-categories><title-group><article-title>Несращения переломов ладьевидной кости и методы лечения  при SNAC‑синдроме</article-title><trans-title-group xml:lang="en"><trans-title>Scaphoid nonunion and SNAC treatment</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Щудло</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Shchudlo</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Наталья Анатольевна Щудло — доктор медицинских наук, ведущий научный сотрудник</p><p>Курган</p></bio><bio xml:lang="en"><p>Natalya A. Shchudlo — Doctor of Medical Sciences, Leading Researcher</p><p>Kurgan</p></bio><email xlink:type="simple">nshchudlo@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-1072-468X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Куттыгул</surname><given-names>Ш. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Kuttygul</surname><given-names>Sh. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шынгыс Кайырбекулы Куттыгул — аспирант</p><p>Курган</p></bio><bio xml:lang="en"><p>Shyngys K. Kuttygul — graduate student</p><p>Kurgan</p></bio><email xlink:type="simple">artana.kaz@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. Илизарова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Ilizarov National Medical Research Centre for Traumatology and Orthopedics</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>22</day><month>02</month><year>2025</year></pub-date><volume>31</volume><issue>1</issue><fpage>91</fpage><lpage>100</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Щудло Н.А., Куттыгул Ш.К., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Щудло Н.А., Куттыгул Ш.К.</copyright-holder><copyright-holder xml:lang="en">Shchudlo N.A., Kuttygul S.K.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.ilizarov-journal.com/jour/article/view/3168">https://www.ilizarov-journal.com/jour/article/view/3168</self-uri><abstract><sec><title>Введение</title><p>Введение. Несращение ладьевидной кости может приводить к развитию прогрессирующего коллапса запястья, — SNAC-синдрому (англ.: Scaphoid Nonunion Advanced Collapse), существенно снижающему качество жизни молодых пациентов. Высокая социальная значимость данного патологического состояния обуславливает актуальность дальнейших оригинальных исследований и анализа литературы.</p><p>Цель работы — определение методов профилактики несращений ладьевидной кости и улучшения результатов лечения пациентов со SNAC-синдромом на основании анализа литературы об этиологии, диагностике и лечении заболевания.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Поиск, проведённый в электронных базах eLIBRARY и Pubmed по запросам: несращение ладьевидной кости, ладьевидная кость, костная пластика, scaphoid nonunion, scaphoid, bone graft, vascularized bone graft, дал 355 результатов. Критерии включения: оригинальные статьи, систематические обзоры, мета-анализы, соответствующие теме поиска, на русском и английском языках. Критерии невключения: клинический случай, случай/контроль, а также статьи, доступные только на платной основе. Отобрано 67 статей. Хронологические рамки публикаций — с 1984 до 2024 гг.</p></sec><sec><title>Результаты и обсуждение</title><p>Результаты и обсуждение. Топография ладьевидной кости обуславливает высокую частоту аваскулярного некроза, замедленного сращения и несращения перелома. Для улучшения диагностики переломов ладьевидной кости в остром периоде травмы необходимо использовать комплекс клинических тестов и лучевых методов, а для определения показаний к операции — учитывать критерии нестабильности перелома. Известна тактическая классификация несращений ладьевидной кости для выбора метода хирургического лечения (остеосинтез компрессирующими винтами, некрэктомия и костные трансплантаты, либо «спасительные» операции). Единичные публикации посвящены эффективности применения аппарата Илизарова в лечении несращений ладьевидной кости без применения открытых доступов и трансплантатов. Лечение пациентов со SNAC-синдромом традиционно определяется стадией заболевания: 1 — реконструкция ладьевидной кости, резекция шиловидного отростка лучевой кости; 2–3 — четырехугольный артродез или резекция проксимального ряда костей запястья. Мета-анализы отмечают необходимость дальнейших исследований эффективности различных методов лечения. В хирургии запястья всё более широкое применение находит артроскопическая техника, улучшающая возможности диагностики и малоинвазивных операций.</p></sec><sec><title>Заключение</title><p>Заключение. Своевременное достижение сращения перелома ладьевидной кости — основной путь профилактики карпальной нестабильности и SNAC-синдрома. При выборе метода лечения пациентов с SNAC-синдромом, наряду со стадией заболевания, необходимо учитывать функциональные потребности пациента.</p></sec></abstract><trans-abstract xml:lang="en"><p>Introduction Scaphoid nonunion can result in progressive scaphoid nonunion advanced collapse (SNAC) and  have an impact on the quality of life in younger patients. The social significance of the pathological condition induces original research and literature analysis.</p><p>The objective was to identify methods for preventing scaphoid nonunion and improving treatment outcomes for SNAC patients based on the literature on etiology, diagnosis and treatment of the disease.</p><p>Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org) and using the  keywords: scaphoid nonunion, scaphoid, bone grafting, scaphoid nonunion, vascularized bone graft. The  search yielded 355 results. Literature searches included both Russian and English studies published between 1984 and 2024. Inclusion criteria included original articles, systematic reviews, meta-analyses relevant to the search topic. Non-inclusion criteria included a case report, case/control, and articles available only on a fee-paying basis. There were 67 articles identified.</p><p>Results and discussion The topography of the scaphoid is associated with a high incidence of avascular necrosis, delayed healing and fracture nonunion. Clinical testing and imaging are essential for diagnosis of scaphoid fractures in the acute period of injury, and fracture instability would be important for surgical indications. There is a classification of scaphoid nonunions that is practical for the choice of a surgical treatment (osteosynthesis with compression screws, debridement and bone grafts or “salvage” operations). Scaphoid nonunions treated with the Ilizarov method employing no open approaches or grafts was reported in  a few publications. Treatment of SNAC patients is traditionally based on the stage of the disease: 1 —  scaphoid reconstruction, resection of the styloid process of the radius; 2–3 — 4-corner arthrodesis or the proximal row carpectomy. Meta-analyses highlight the need for the research into the effectiveness of  various treatments. Arthroscopic techniques are common in wrist surgery improving diagnostic capabilities and minimally invasive interventions.</p><p>Conclusion Timely healing of a scaphoid fracture is essential for preventing carpal instability and SNAC. The choice of SNAC treatment is associated with the stage of the disease and functional needs of the patient.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>несращение ладьевидной кости</kwd><kwd>ладьевидная кость</kwd><kwd>чрескожная фиксация</kwd><kwd>костный трансплантат</kwd><kwd>кровоснабжаемый костный трансплантат</kwd><kwd>SNAC-синдром</kwd></kwd-group><kwd-group xml:lang="en"><kwd>scaphoid nonunion</kwd><kwd>scaphoid</kwd><kwd>percutaneous fixation</kwd><kwd>bone graft</kwd><kwd>vascularized bone graft</kwd><kwd>SNAC</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Shahabpour M, Abid W, Van Overstraeten L, De Maeseneer M. Wrist Trauma: More Than Bones. J Belg Soc Radiol. 2021;105(1):90. doi: 10.5334/jbsr.2709.</mixed-citation><mixed-citation xml:lang="en">Shahabpour M, Abid W, Van Overstraeten L, De Maeseneer M. Wrist Trauma: More Than Bones. 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