Luchetti Timothy J, Rao Allison J, Fernandez John J, Cohen Mark S, Wysocki Robert W
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Hand Surg Eur Vol. 2018 Jan;43(1):66-72. doi: 10.1177/1753193417743438. Epub 2017 Nov 22.
We present 20 patients with established proximal pole scaphoid nonunions treated with curettage and cancellous autograft from the distal radius and screw fixation. Fractures with significant proximal pole fragmentation were excluded. Patients were treated at a mean of 26 weeks after injury (range 12-72). Union occurred in 18 of 20 patients (90%) based on computed tomographic imaging. The two nonunions that did not heal were treated with repeat curettage and debridement and iliac crest bone grafting without revision of fixation. Union was achieved in both at a mean of 11 weeks after the revision procedures. Our findings suggest that non-vascularized cancellous autograft and antegrade fixation is a useful option for the treatment of proximal pole scaphoid nonunions.
IV.
我们报告了20例已确诊的舟骨近端骨折不愈合患者，采用桡骨远端松质骨自体骨刮除植骨及螺钉固定治疗。排除近端极严重碎裂的骨折。患者受伤后平均26周接受治疗（范围12 - 72周）。根据计算机断层扫描成像，20例患者中有18例（90%）实现了愈合。2例未愈合的骨折不愈合患者接受了重复刮除和清创以及髂嵴骨移植，未进行内固定翻修。翻修手术后平均11周，二者均实现了愈合。我们的研究结果表明，非血管化松质骨自体骨移植和顺行固定是治疗舟骨近端骨折不愈合的一种有效选择。
IV级。
