Hand and Microsurgery Section, Orthopaedic Department, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
J Orthop Trauma. 2012 Apr;26(4):241-5. doi: 10.1097/BOT.0b013e31821f940a.
Untreated scaphoid nonunions are a hazard to the wrist, resulting in deteriorating function and radiologic degenerative changes with increasing time. Long-term results after surgery of scaphoid nonunion reporting clinical, radiologic, and subjective outcomes are scarce.
Retrospective follow-up study.
From 1990 to 1998, 53 patients were operated on for persistent scaphoid nonunion; three patients were excluded from the follow-up (one expelled foreigner, another died of an unrelated cause, one never appeared after surgery), leaving 50 patients eligible for follow-up.
All patients were operated on with open reduction and internal fixation; the majority also received a bone graft.
Radiology and computed tomography verified union, degenerative wrist changes, and final salvage treatment. Range of motion, grip strength, key pinch, and subjective outcome (QuickDASH, visual analog scale).
Fifty patients were followed up after a mean of 12.2 years (standard deviation [SD], 3.0), 47 by clinical and radiologic examination; three were interviewed by telephone and completed QuickDASH and visual analog scale forms. Union was achieved in 45 of 50 scaphoids and an additional two after a second attempt. Five patients (one persistent and four healed nonunions) underwent salvage procedures. Grip strength (41 vs 45 kg, P = nonsignificant), key pinch (11.5 vs 12.4, P = nonsignificant), and active range of motion (186° vs 214°, P < 0.001) were slightly reduced compared with the uninjured side. The subjective outcome was good (mean visual analog scale = 7, mean QuickDASH = 9.1). Minor degenerative changes were seen in nine wrists at surgery and 22 at follow-up.
Healing of a scaphoid nonunion provides long-term pain relief, excellent wrist function, and halts degenerative changes in the majority of patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
未经治疗的舟状骨骨不连对腕关节是一种危害，随着时间的推移，会导致功能恶化和放射学退行性改变。手术治疗舟状骨骨不连后报告临床、放射学和主观结果的长期结果很少。
回顾性随访研究。
1990 年至 1998 年，53 例患者因持续性舟状骨骨不连接受手术治疗；3 例患者因随访（1 例为外国人，另 1 例因其他原因死亡，1 例手术后从未出现）而被排除在外，50 例患者符合随访条件。
所有患者均行切开复位内固定术；大多数患者还接受了植骨。
影像学和计算机断层扫描证实愈合、腕关节退行性改变和最终挽救治疗。活动范围、握力、关键捏力和主观结果（QuickDASH、视觉模拟评分）。
50 例患者平均随访 12.2 年（标准差[SD]，3.0），47 例患者接受临床和影像学检查；3 例患者通过电话访谈并完成了 QuickDASH 和视觉模拟评分表。50 例舟状骨中有 45 例愈合，另外 2 例经再次尝试后愈合。5 例患者（1 例持续性和 4 例愈合性骨不连）接受了挽救治疗。握力（41 对 45 千克，P = 非显著性）、关键捏力（11.5 对 12.4，P = 非显著性）和主动活动范围（186°对 214°，P < 0.001）与未受伤侧相比略有降低。主观结果良好（平均视觉模拟评分=7，平均 QuickDASH=9.1）。9 例在手术时和 22 例在随访时出现轻微退行性改变。
舟状骨骨不连的愈合可为大多数患者提供长期疼痛缓解、良好的腕关节功能，并阻止退行性改变。
治疗水平 IV。请参阅作者说明，以获取完整的证据水平描述。
