Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Orthop Traumatol Surg Res. 2018 Feb;104(1):115-120. doi: 10.1016/j.otsr.2017.11.011. Epub 2017 Dec 16.
This study was undertaken to determine whether corticocancellous bone grafting and cancellous bone grafting differ in terms of bone union rate, restoration of scaphoid anatomy, and wrist function when unstable scaphoid nonunions are concomitantly treated by screw fixation.
This is retrospective cohort study. In Group A (17 patients), unstable scaphoid nonunion was treated with corticocancellous graft harvested from the iliac crest and headless compression screw using volar approach. In Group B (18 patients), unstable scaphoid nonunion was treated with cancellous graft harvested from the distal radius or iliac crest and headless compression screw using volar approach Mean time to union was measured using CT image. Scaphoid deformity was also measured using lateral intrascaphoid angle and height to length ratio using CT images. Wrist functional status was assessed by measuring grip strength, wrist range of motion, and DASH score at 1 year postoperatively.
Mean time to union was significantly greater in Group A (15 weeks vs. 11 weeks). No significant intergroup difference was observed for lateral intrascaphoid angle and height to length ratio after treatment of scaphoid nonunion. No significant intergroup difference was observed for grip strength, wrist range of motion, or DASH scores at 1 year postoperatively.
Cancellous bone grafting was found to lead to earlier bone union than corticocancellous bone grafting and to similar restorations of scaphoid deformity and wrist function when scaphoid nonunion was treated by headless compression screw fixation and bone grafting.
Prognostic, III.
本研究旨在确定在通过无头加压螺钉固定和植骨同时治疗不稳定舟骨骨折不愈合时，皮质松质骨移植和松质骨移植在骨愈合率、舟骨解剖结构恢复和腕关节功能方面是否存在差异。
这是一项回顾性队列研究。在 A 组（17 例）中，通过掌侧入路使用取自髂嵴的皮质松质骨移植物和无头加压螺钉治疗不稳定舟骨骨折不愈合。在 B 组（18 例）中，通过掌侧入路使用取自桡骨远端或髂嵴的松质骨移植物和无头加压螺钉治疗不稳定舟骨骨折不愈合。使用 CT 图像测量愈合时间。使用 CT 图像测量舟骨畸形，包括舟骨侧位角和高度与长度比。术后 1 年通过测量握力、腕关节活动范围和 DASH 评分评估腕关节功能状态。
A 组的愈合时间明显长于 B 组（15 周比 11 周）。治疗舟骨骨折不愈合后，两组间舟骨侧位角和高度与长度比无显著差异。术后 1 年，两组间握力、腕关节活动范围或 DASH 评分无显著差异。
无头加压螺钉固定和植骨治疗舟骨骨折不愈合时，松质骨移植较皮质松质骨移植可更早愈合，且在恢复舟骨畸形和腕关节功能方面相似。
预后，III 级。
