Ruch David S, Papadonikolakis Anastasios
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
J Hand Surg Am. 2006 Apr;31(4):588-93. doi: 10.1016/j.jhsa.2005.12.027.
To evaluate the results of resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed prior surgical treatment.
Thirteen patients who were treated with resection of the scaphoid distal pole for persistent nonunion after previous surgical treatment were included in this study. The mean follow-up period was 5 years. Evaluation included measurement of wrist range of motion, assessment of pain, and evaluation of radiographic parameters. The Disabilities of the Arm, Shoulder, and Hand score was used to determine the functional outcome after the excision.
Before surgery all but 1 patient reported pain. After surgery 2 patients presented with mild pain during strenuous activity. Mean wrist flexion and extension increased significantly, by 23 degrees and 29 degrees, respectively. The postoperative Disabilities of the Arm, Shoulder, and Hand score was 25 +/- 19 points. There was a significant increase in the radiolunate angle, indicating dorsal intercalated segment instability deformity in 6 patients.
Scaphoid distal pole excision remains a valuable treatment option for patients for whom multiple attempts at union have failed previously and who have no associated complete scapholunate ligament tears.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
评估在先前手术治疗失败后，对有症状的舟状骨不愈合进行舟状骨远极切除术的结果。
本研究纳入了13例在先前手术治疗后因持续性不愈合而接受舟状骨远极切除术的患者。平均随访期为5年。评估包括测量腕关节活动范围、疼痛评估和影像学参数评估。采用手臂、肩部和手部功能障碍评分来确定切除术后的功能结果。
术前除1例患者外，所有患者均报告有疼痛。术后2例患者在剧烈活动时出现轻度疼痛。腕关节平均屈曲和伸展分别显著增加23度和29度。术后手臂、肩部和手部功能障碍评分为25±19分。桡月角显著增加，表明6例患者存在背侧嵌入节段不稳定畸形。
对于先前多次融合尝试失败且没有相关舟月韧带完全撕裂的患者，舟状骨远极切除术仍然是一种有价值的治疗选择。
研究类型/证据水平：治疗性研究，四级证据。
