Rancy Schneider K, Swanstrom Morgan M, DiCarlo Edward F, Sneag Darryl B, Lee Steve K, Wolfe Scott W
1 College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
2 Department of Orthopedic Surgery, Hospital for Special Surgery/Weill Medical College of Cornell University, New York, NY, USA.
J Hand Surg Eur Vol. 2018 Jan;43(1):32-40. doi: 10.1177/1753193417732003. Epub 2017 Sep 24.
We followed 35 consecutive patients with scaphoid nonunions in a prospective longitudinal registry. All nonunions were treated with curettage, non-vascularized autogenous grafting and headless screw fixation. Preoperative magnetic resonance imaging, intraoperative bleeding points and histopathological analysis of cancellous bone in the proximal pole were recorded as measures of viability. Healing was categorized as ≥50% bony bridging on computed tomographic images in the plane of the scaphoid. Nine of 23 proximal poles demonstrated ischaemia on magnetic resonance imaging but none were interpreted as infarcted. Twenty-eight of 33 were found to have impaired vascularity as assessed by intraoperative bleeding. Fourteen of 32 demonstrated ≥50% trabecular necrosis and four of 33 demonstrated ≥50% tissue necrosis on histopathological analysis. Thirty of 33 demonstrated focal or robust remodelling activity. Despite pathological evidence of impaired vascularity in over half of the patients, 33 of the 35 scaphoids had healed by 12 weeks. We conclude that proximal pole infarction is decidedly rare and that vascularized bone grafting is seldom required.
IV.
我们在一个前瞻性纵向登记研究中追踪了35例连续的舟骨不愈合患者。所有不愈合均采用刮除、非带血管自体骨移植和无头螺钉固定治疗。术前磁共振成像、术中出血点以及近端极的松质骨组织病理学分析被记录为活力指标。愈合被定义为在舟骨平面的计算机断层扫描图像上骨桥接≥50%。23个近端极中有9个在磁共振成像上显示缺血，但均未被判定为梗死。33例中有28例经术中出血评估显示血管受损。32例中有14例在组织病理学分析中显示≥50%的小梁坏死，33例中有4例显示≥50%的组织坏死。33例中有30例显示有局灶性或活跃的重塑活动。尽管超过半数患者有血管受损的病理证据，但35例舟骨中有33例在12周时已愈合。我们得出结论，近端极梗死极为罕见，很少需要带血管骨移植。
IV级。
