Raju P K, Kini Sunil Gurpur
Department of Orthopaedics, Bangalore Medical College and Research Institute, Karnataka, India.
J Orthop Surg (Hong Kong). 2011 Apr;19(1):80-4. doi: 10.1177/230949901101900119.
To compare outcomes of 3 fixation modalities for scaphoid non-union.
27 men and 6 women aged 20 to 48 (mean, 28) years with non-union of the scaphoid involving the proximal pole (n=13), waist (n=12), and distal pole (n=8) were randomised to undergo the Herbert screw fixation (n=11), the Matti Russe bone grafting (n=9), or the Kohlman modification of vascularised muscle pedicle graft procedure (n=13). The mean duration of non-union was 10 (range, 6-30) months.
The mean follow-up duration was 28 months. 30 of 33 achieved correction of both scapholunate and radiolunate angles. The mean range of motion increased from 112 to 155 degrees. The mean grip strength increased by 30%. Functional outcomes of the 3 groups were comparable; they were excellent in 13 patients, good in 10, fair in 6, and poor in 4. There was no hardware failure or any iatrogenic fracture during pedicle dissection. One patient had a superficial infection, which was resolved after antibiotic treatment. At the 6-month follow-up, in the respective 3 groups, 8, 6 and 11 patients achieved scaphoid union after mean intervals of 17, 16, and 15 weeks.
The time to union was earliest in the Kohlman modification of vascularised muscle pedicle graft procedure, which is recommended for patients with old non-union (>1 year) or proximal pole fractures.
比较舟骨不愈合的三种固定方式的疗效。
27名男性和6名女性，年龄20至48岁（平均28岁），舟骨不愈合累及近极（n = 13）、腰部（n = 12）和远极（n = 8），随机接受Herbert螺钉固定（n = 11）、Matti Russe植骨术（n = 9）或带血管蒂肌蒂移植术的Kohlman改良术（n = 13）。不愈合的平均持续时间为10个月（范围6 - 30个月）。
平均随访时间为28个月。33例中的30例舟月角和桡月角均得到矫正。平均活动范围从112度增加到155度。平均握力增加了30%。三组的功能结果相当；13例患者为优，10例为良，6例为可，4例为差。在蒂部解剖过程中未出现内固定失败或任何医源性骨折。1例患者发生浅表感染，经抗生素治疗后痊愈。在6个月随访时，在各自的三组中，8例、6例和11例患者分别在平均17周、16周和15周后实现舟骨愈合。
带血管蒂肌蒂移植术的Kohlman改良术愈合时间最早，推荐用于陈旧性不愈合（>1年）或近极骨折患者。
