Lee Young-Keun, Choi Kwang-Wook, Woo Sang-Hyun, Ho Pak Cheong, Lee Malrey
Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, Republic of Korea Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Shatin, N.T., Hong Kong The Research Center for Advanced Image and Information Technology, School of Electronics & Information Engineering, Chonbuk National University, JeonJu, Chonbuk, Republic of Korea.
Medicine (Baltimore). 2018 Mar;97(13):e9987. doi: 10.1097/MD.0000000000009987.
The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3-10) preoperatively to 1.59 (range, 0-3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.
本研究的目的是分析采用关节镜下植骨及克氏针固定治疗舟骨不愈合患者的临床结果。我们回顾性分析了2008年11月至2014年2月期间采用关节镜下植骨及克氏针固定方法治疗的27例舟骨不愈合患者的病历。患者平均年龄为35岁。从受伤到治疗的平均时间为45个月。平均随访期为18个月。采用系列X线平片评估骨愈合情况。通过比较术前和末次随访时的改良梅奥腕关节评分与视觉模拟疼痛量表（VAS）来评估功能结果。27例不愈合患者中有26例（96.29%）实现了愈合。平均放射学愈合时间为10周。平均VAS评分从术前的6.38（范围3 - 10）降至末次随访时的1.59（范围0 - 3）。平均改良梅奥腕关节评分从术前的60.19提高到末次随访时的83.46。根据该评分，末次随访时有12例优、6例良和9例可。关节镜下植骨及经皮克氏针固定是治疗舟骨不愈合的一种有效方法，具有可进行全面评估、能以微创方式对舟骨不愈合采取综合管理方法的优点，且该方法也可用于SNAC I期的舟骨不愈合。
