Uludag University Faculty of Medicine, Department of Orthopaedics, Hand Surgery Clinic, Bursa, Turkey.
Akdeniz University Faculty of Medicine, Department of Orthopaedics, Antalya, Turkey.
Injury. 2021 Aug;52(8):2307-2313. doi: 10.1016/j.injury.2020.02.037. Epub 2020 Feb 12.
Aim of the present study was to evaluate the clinical, functional, and radiological outcomes of 1,2-intercompartmental supraretinacular artery (1.2-ICSRA) vascularized graft technique together with compression screw fixation for the management of scaphoid nonunions.
A retrospective study was designed to evaluate the medical records of the 21 patients treated with 1,2-ICSRA vascularized graft for established scaphoid nonunion of the waist or proximal pole between 2015 and 2018. Seventeen patients who met the criteria were included in the study. The retrospectively analysed demographic parameters included age, gender, injured hand (dominant/non-dominant), aetiology of the injury, delay between injury and operation, initial treatments following the fracture, tobacco use, and background diseases that may affect healing (diabetes, vasculopathy etc.). Radiological and clinical examinations were routinely performed 2 weeks, 6 weeks, 3 months and 6 months after surgery and during the final follow-up. Postoperative clinical and functional outcomes at the latest follow-up were evaluated by measuring active wrist range of motion, grip strength, Turkish version of Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Quick DASH) and Mayo Wrist scores and comparing them with preoperative values.
All 17 patients were male with an average age of 26.82 ± 4.08 years (range 20-35 years). The fracture site was located in the scaphoid waist and proximal pole in 5 (29.4%) and 12 (70.6%) patients, respectively. Avascular necrosis was observed in 13 patients (2 at the waist, 11 at the proximal pole). The mean follow-up duration was 18.88 ± 11.98 months (range 6-44 months). No graft extrusion occurred, and no other complication was observed in any of the patients. Amongst the 17 patients, 15 (88.2%) achieved union. The total wrist motions of patients were better postoperatively than preoperatively. However, only improvement in wrist extension was found to be statistically significant. Quick DASH and Mayo Wrist scores of the patients and grip strength were significantly improved postoperatively.
The 1,2-ICSRA vascularized graft technique together with compression screw fixation offers an easy and reliable option for the treatment of scaphoid nonunions with a high union rate and good functional and clinical outcomes.
IV Therapautic.
本研究旨在评估 1,2-骨间掌侧动脉（1,2-ICSRA）血管化移植物技术联合加压螺钉固定治疗舟状骨骨不连的临床、功能和影像学结果。
设计回顾性研究，评估 2015 年至 2018 年间采用 1,2-ICSRA 血管化移植物治疗舟状骨腰部或近极骨不连的 21 例患者的病历。符合标准的 17 例患者纳入研究。回顾性分析的人口统计学参数包括年龄、性别、受伤手（优势/非优势）、损伤原因、损伤与手术之间的时间延迟、骨折后的初始治疗、吸烟以及可能影响愈合的基础疾病（糖尿病、血管病等）。术后 2 周、6 周、3 个月和 6 个月以及末次随访时进行常规影像学和临床检查。末次随访时，通过测量主动腕关节活动度、握力、土耳其版的上肢残疾问卷（Quick DASH）和 Mayo 腕关节评分，评估术后临床和功能结果，并与术前值进行比较。
17 例患者均为男性，平均年龄 26.82±4.08 岁（范围 20-35 岁）。骨折部位位于舟骨腰部 5 例（29.4%），近极 12 例（70.6%）。13 例（2 例在腰部，11 例在近极）发生缺血性坏死。平均随访时间为 18.88±11.98 个月（范围 6-44 个月）。无移植物挤出，无其他并发症。17 例患者中，15 例（88.2%）达到愈合。与术前相比，术后患者的总腕关节活动度更好。然而，只有腕关节伸展的改善具有统计学意义。术后患者的 Quick DASH 和 Mayo 腕关节评分以及握力均显著改善。
1,2-ICSRA 血管化移植物技术联合加压螺钉固定治疗舟状骨骨不连，具有较高的愈合率、良好的功能和临床结果，是一种简单可靠的选择。
IV 治疗。
