Sander A L, Sommer K, Schäf D, Braun C, Marzi I, Pohlemann T, Frank J
Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Eur J Trauma Emerg Surg. 2018 Feb;44(1):113-118. doi: 10.1007/s00068-017-0773-y. Epub 2017 Feb 27.
Achieving stable fixation of scaphoid fractures and nonunions continues to be a challenge. Compression screw fixation has been the current standard surgical procedure. However, in some cases, bone healing cannot be achieved and requires further revision. Recent series reintroduced volar plating as valid option for stable fixation. The aim of the study was to review clinical outcome of alternative scaphoid treatment.
From 2011 to 2014, nine patients with scaphoid fracture were treated by Headless Compression Screw (HCS) and seven patients with scaphoid nonunion by HCS or volar mini condylar plate with bone graft. The average age was 34.4 years and the average time to follow-up was 19.3 months. From 1996 to 1998, 38 patients with scaphoid nonunion were treated using compression screw (S-group) or volar mini condylar plate (P-group) with bone graft. The average age was 39.6 years and the average time to follow-up was 26.2 months.
The union rate was 100%. For scaphoid fractures, the mean Modified Mayo Wrist Score (MMWS) was 94.1 and the DASH score 7.4. From 2011 to 2014, the MMWS was 87.9 and the DASH score 7 in scaphoid nonunions. In the period between 1996 and 1998, the MMWS was 67.2 in the P-group and 58.6 in the S-group, and the DASH score 16.8 and 28.2.
Our study demonstrated that appropriate application of the HCS was able to produce very satisfactory results in scaphoid fractures and nonunions. In our opinion, however, the method of scaphoid plate osteosynthesis can achieve a higher degree of stability, particularly rotational stability, in case of multifragmentary avascular scaphoid nonunions.
实现舟骨骨折和骨不连的稳定固定仍然是一项挑战。加压螺钉固定一直是当前的标准外科手术方法。然而，在某些情况下，无法实现骨愈合，需要进一步翻修。最近的系列研究重新引入掌侧钢板作为稳定固定的有效选择。本研究的目的是回顾舟骨替代治疗的临床结果。
2011年至2014年，9例舟骨骨折患者采用无头加压螺钉（HCS）治疗，7例舟骨骨不连患者采用HCS或带植骨的掌侧微型髁钢板治疗。平均年龄为34.4岁，平均随访时间为19.3个月。1996年至1998年，38例舟骨骨不连患者采用加压螺钉（S组）或带植骨的掌侧微型髁钢板（P组）治疗。平均年龄为39.6岁，平均随访时间为26.2个月。
愈合率为100%。对于舟骨骨折，改良梅奥腕关节评分（MMWS）平均为94.1，DASH评分为7.4。2011年至2014年，舟骨骨不连患者的MMWS为87.9，DASH评分为7。在1996年至1998年期间，P组的MMWS为67.2，S组为58.6，DASH评分为16.8和28.2。
我们的研究表明，适当应用HCS能够在舟骨骨折和骨不连中产生非常满意的结果。然而，我们认为，在多片段无血管舟骨骨不连的情况下，舟骨钢板骨合成方法可以实现更高程度的稳定性，特别是旋转稳定性。
