Reigstad O, Thorkildsen R, Grimsgaard C, Reigstad A, Røkkum M
Hand and Microsurgery Section, Orthopaedic Department, Rikshospitalet, Oslo, Norway.
J Hand Surg Eur Vol. 2009 Dec;34(6):772-7. doi: 10.1177/1753193409346093. Epub 2009 Sep 28.
Eighteen patients who underwent revision non-vascularized bone grafting and internal fixation after failed surgery for scaphoid nonunion were reviewed after a minimum of 8.2 years. Eleven of the nonunions were located in the middle and seven in the proximal third of the scaphoid. The mean interval between injury and the revision procedure was 6 years. Sixteen of the 18 nonunions healed, two after a third attempt. Three patients with healed nonunions and one patient with persistent nonunion required salvage procedures for progressive radiocarpal arthrosis. In the remaining 14 cases, the mean loss of wrist flexion/extension arc compared to the contralateral wrist was 36 degrees . Mean reduction of grip strength and key pinch was 9.3 kg and 0.9 kg respectively. The QuickDASH score was 18 and a visual analogue pain score was 21/100 at follow-up. Wrist degeneration increased in all but one case during the observation period. Thirteen of 16 patients with union and one patient with a persisting nonunion experienced moderate symptoms.
对18例舟骨不愈合手术失败后接受翻修非血管化骨移植和内固定的患者进行了至少8.2年的随访。其中11例不愈合位于舟骨中部，7例位于舟骨近端三分之一处。受伤至翻修手术的平均间隔时间为6年。18例不愈合中有16例愈合，2例在第三次尝试后愈合。3例不愈合已愈合的患者和1例持续不愈合的患者因进行性桡腕关节病需要挽救手术。在其余14例中，与对侧腕关节相比，腕关节屈伸弧的平均损失为36度。握力和捏力分别平均降低9.3 kg和0.9 kg。随访时QuickDASH评分为18分，视觉模拟疼痛评分为21/100。在观察期内，除1例患者外，所有患者的腕关节退变均加重。16例愈合患者中的13例和1例持续不愈合患者出现中度症状。
