Vanhees Matthias, van Riet Roger R P, van Haver Annemieke, Kebrle Radek, Meermans Geert, Verstreken Frederik
Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium.
Department of Orthopedic Surgery, Antwerp University Hospital, Antwerp, Belgium.
J Wrist Surg. 2017 Aug;6(3):183-187. doi: 10.1055/s-0036-1597681. Epub 2016 Dec 28.
We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting. Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients with bone graft, sclerotic bone debridement, or displacement of the fragment at the nonunion site were excluded. A percutaneous transtrapezial fixation technique was used in all cases. Patients were reviewed until clinical and radiographic union was observed. At the final follow-up, DASH (Disabilities of the Arm, Shoulder and Hand) and PRWHE (Patient-Rated Wrist and Hand Evaluation) outcome scores were completed. Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow-up of 36 months (range: 12-98 months). No complications from the percutaneous technique were noted. The average DASH score was 6 (range: 0-39) and the average PRWHE score was 10 (range: 0-56). No statistical significant difference in range of motion and grip strength was found between the operated side and the contralateral side. Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid fractures without bone grafting is promising. At a mean of 4 months, 94% union was obtained with good functional results when there was no sclerosis, minimal osteolysis, and no displacement at the scaphoid nonunion site. Therapeutic study. IV.
我们评估了使用无头骨螺钉且不进行植骨的经皮经舟状骨固定术治疗舟状骨延迟愈合或不愈合的临床及影像学结果。
本回顾性研究纳入了2006年至2011年间16例舟状骨延迟愈合或不愈合的患者。所有患者均有舟状骨骨折延迟就诊情况,且均未在其他地方接受过保守治疗。排除有植骨、硬化骨清创或骨折不愈合部位骨块移位的患者。所有病例均采用经皮经舟状骨固定技术。对患者进行随访,直至观察到临床及影像学愈合。在末次随访时,完成了上肢、肩部和手部功能障碍(DASH)及患者自评腕关节和手部评估(PRWHE)结果评分。
16例患者中有15例(94%)在平均36个月(范围:12 - 98个月)的随访后获得影像学愈合。未发现经皮技术相关并发症。平均DASH评分为6分(范围:0 - 39分),平均PRWHE评分为10分(范围:0 - 56分)。手术侧与对侧在活动范围和握力方面未发现统计学显著差异。
对于选定的无植骨的舟状骨骨折延迟愈合或不愈合,经皮经舟状骨螺钉固定术前景良好。当舟状骨骨折不愈合部位无硬化、最小程度骨质溶解且无移位时,平均4个月时94%的患者获得愈合,功能结果良好。 治疗性研究。 IV。
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