Gvozdenovic Robert, Joergensen Rasmus Wejnold, Joerring Stig, Jensen Claus Hjort
Gentofte/Herlev Hospital, University of Copenhagen, Department of Orthopedic Surgery, Hand Surgery Unit, Gentofte Hospital, Kildegårdsvej, Hellerup, Denmark.
J Wrist Surg. 2020 Feb;9(1):13-18. doi: 10.1055/s-0039-1693146. Epub 2019 Jul 5.
Minimally invasive techniques have been recommended in the treatment of painful but stable scaphoid nonunions. The purpose of this study was to determine if arthroscopically assisted bone grafting provided superior results in healing as compared to percutaneous screw fixation. One hundred sixty-four consecutive patients with scaphoid nonunions were retrospectively analyzed. One hundred forty-eight patients were treated with the open grafting techniques either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously ( = 8), the time from injury to surgery was 2.5 months (range: 2-4 months) and it was 27.3 months (range: 3-180 months) in the arthroscopic group ( = 8). The mean age was 39 years (range: 20-66) in the percutaneous group and 22 years (range: 16-32) in the arthroscopic group. In all cases, the Mini Acutrak headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks, mean 7 months (range: 3-12 months). Data were calculated with two-tailed Mann-Whitney test based on -value of < 0.05 that was considered statistically significant. We recorded no complications in any of the groups. Patients treated arthroscopically received cancellous bone grafting from the distal radius and all patients but one healed at a median of 7.8 weeks (range: 5-18 weeks). Seven patients in the percutaneous group healed at a mean of 10.5 weeks (range: 7-24 weeks), thus leaving one patient from each group without achieving union. Mann-Whitney test showed the value of 11, the critical value of to be 13 ( < 0.05), thus significantly faster healing was observed in the arthroscopically treated group. Arthroscopically treated patients achieved faster healing despite shorter time to surgery in the percutaneous group. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. This is a Level III comparative study.
对于疼痛但稳定的舟骨不愈合的治疗，推荐采用微创技术。本研究的目的是确定与经皮螺钉固定相比，关节镜辅助下植骨在愈合方面是否能提供更好的效果。
对164例连续的舟骨不愈合患者进行了回顾性分析。148例患者采用开放植骨技术，使用髂骨或桡骨远端骨，其余16例患者接受了微创手术治疗。经皮治疗组（n = 8）从受伤到手术的时间为2.5个月（范围：2 - 4个月），关节镜组（n = 8）为27.3个月（范围：3 - 180个月）。经皮组的平均年龄为39岁（范围：20 - 66岁），关节镜组为22岁（范围：16 - 32岁）。所有病例均使用Mini Acutrak无头全螺纹加压螺钉。在至少12周的随访（平均7个月，范围：3 - 12个月）时，通过临床和影像学评估愈合情况。基于p值<0.05进行双尾曼-惠特尼U检验计算数据，p值<0.05被认为具有统计学意义。
我们记录到所有组均无并发症。接受关节镜治疗的患者从桡骨远端获取松质骨植骨，除1例患者外，所有患者均在中位时间7.8周（范围：5 - 18周）愈合。经皮组7例患者平均在10.5周（范围：7 - 24周）愈合，因此每组各有1例患者未实现愈合。曼-惠特尼U检验显示U值为11，临界值U为13（p < 0.05），因此在关节镜治疗组观察到愈合明显更快。
尽管经皮组手术时间更短，但关节镜治疗的患者愈合更快。局部植骨被认为是这一结果的主要原因。关节镜治疗组中较年轻的人群可能影响了结果。
这是一项III级比较研究。
