Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor 48109-5340, MI, United States.
Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
Injury. 2020 Mar;51(3):656-662. doi: 10.1016/j.injury.2020.01.035. Epub 2020 Jan 28.
We aimed (1) to discover the prevalence of vascularized bone grafting in the treatment of scaphoid nonunion and (2) to compare healing using vascularized bone grafting versus standard non-vascularized techniques. Secondarily, we sought to compare resource utilization between procedures and identify factors that may be associated with nonunion repair failure. We hypothesized that, despite being less common, vascularized bone grafts have greater success than non-vascularized bone grafting surgeries.
We performed a large population analysis using the Truven MarketScan databases to identify patients from 2009 to 2017 with a diagnosis of a scaphoid nonunion undergoing repair surgery with and without the insertion of a pedicled or free vascularized bone graft. We defined any subsequent scaphoid or wrist surgery within 12 months after surgery as surgery failure. We compared success rates and post-operative resource utilization using Chi-squared tests.
Of 4177 eligible patients, 358 underwent nonunion repair with vascularized bone graft and 3819 patients received non-vascularized bone grafting. The failure rate requiring revision surgery was 5.0% in vascularized repair, versus 6.1% for non-vascularized surgery. Age and comorbidities did not affect bone graft type. Areas with higher median household incomes had more vascularized repairs. Vascularized bone graft patients received significantly more therapy and imaging after surgery.
Most scaphoid nonunion repairs are performed without vascularize bone grafting. Typical nonunions may not justify the increased time and technical demands of vascularized bone grafting, and traditional repair should remain first line treatment for scaphoid nonunions without additional risk factors. Further studies to elucidate which fractures benefit most from vascularized grafting are needed.
我们旨在（1）发现血管化骨移植在治疗舟状骨骨不连中的应用情况，（2）比较血管化骨移植与标准非血管化技术的愈合情况。其次，我们试图比较两种手术的资源利用情况，并确定可能与骨不连修复失败相关的因素。我们假设，尽管血管化骨移植的应用较少，但它比非血管化骨移植的成功率更高。
我们使用 Truven MarketScan 数据库进行了一项大型人群分析，以确定 2009 年至 2017 年间患有舟状骨骨不连且接受手术修复的患者，这些患者中有接受带蒂或游离血管化骨移植的患者，也有未接受该手术的患者。我们将术后 12 个月内的任何后续舟骨或腕骨手术定义为手术失败。我们使用卡方检验比较成功率和术后资源利用情况。
在 4177 名符合条件的患者中，有 358 名患者接受了血管化骨移植修复，3819 名患者接受了非血管化骨移植。血管化修复组需要翻修手术的失败率为 5.0%，而非血管化修复组为 6.1%。年龄和合并症并不影响骨移植类型。中位数家庭收入较高的地区血管化修复的比例更高。血管化骨移植患者术后接受了更多的治疗和影像学检查。
大多数舟状骨骨不连修复都不采用血管化骨移植。典型的非愈合可能不需要增加血管化骨移植的时间和技术要求，传统的修复方法仍然是无其他危险因素的舟状骨骨不连的一线治疗方法。需要进一步研究以阐明哪些骨折最受益于血管化移植。
