Louisville, Ky.; and Dallas, Texas From the Department of Surgery, Division of Hand Surgery, University of Louisville School of Medicine; the Christine M. Kleinert Institute for Hand and Microsurgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the School of Public Health and Information Sciences, University of Louisville.
Plast Reconstr Surg. 2011 Aug;128(2):467-473. doi: 10.1097/PRS.0b013e31821e703b.
Percutaneous fixation of fractures of the scaphoid is well documented in the acute setting by both dorsal and volar methods. What is not commonly discussed is the use of this method for delayed unions and nonunions of the scaphoid. The authors present their case series of patients who underwent dorsal percutaneous fixation for delayed union or nonunion of the scaphoid.
This study retrospectively reviewed eight consecutive patients (six male patients and two female patients) with a delayed union (8 to 12 weeks) or nonunion (≥13 weeks) of the scaphoid waist treated with dorsal percutaneous cannulated screw fixation. The indications for surgery included failure of conservative treatment, pain with loss of wrist mobility, and prevention of long-term osteoarthritis. Exclusion criteria included previous surgery, dorsal intercalated segmental instability, fracture displacement of more than 1.0 mm, osteoarthritis, avascular necrosis, and proximal pole nonunion.
The union rate was 100 percent, with an average time to union of 7 weeks for the delayed union group (three of eight) and 13 weeks for the nonunion group (five of eight). No statistically significant difference was found between the preoperative and postoperative radiolunate angles, scapholunate angles, and height-to-length scaphoid ratio. All patients were able to return to their preinjury employment after an average of 10 weeks.
This pilot study demonstrates that the dorsal percutaneous approach to treatment of delayed union and nonunion of stable scaphoid waist fractures can result in predictable union, with minimal morbidity and complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
经皮固定舟状骨骨折在急性和慢性阶段都有很好的文献记载，包括背侧和掌侧入路。但对于延迟愈合和不愈合的治疗方法讨论较少。作者介绍了他们采用背侧经皮固定治疗舟状骨延迟愈合和不愈合的病例系列。
本研究回顾性分析了 8 例（6 例男性，2 例女性）舟状骨腰部延迟愈合（8-12 周）或不愈合（≥13 周）患者，采用背侧经皮空心螺钉固定。手术指征包括保守治疗失败、腕关节活动时疼痛和丧失、预防长期骨关节炎。排除标准包括既往手术、背侧交锁不稳定、骨折移位超过 1.0 毫米、骨关节炎、缺血性坏死和近极不愈合。
愈合率为 100%，延迟愈合组（8 例中的 3 例）平均愈合时间为 7 周，不愈合组（8 例中的 5 例）平均愈合时间为 13 周。术前与术后桡月角、舟月角和舟骨高度与长度比无统计学差异。所有患者平均 10 周后均能恢复受伤前的工作。
这项初步研究表明，稳定的舟状骨腰部骨折延迟愈合和不愈合的背侧经皮治疗方法可获得可预测的愈合，且并发症少。
临床问题/证据水平：治疗，IV。
