Lee Dennis S, Lee David T, Uppuganti Sasidhar, Perrien Daniel S, Pappas Nicholas D, Reasoner Kaitlyn, Lee Donald H
Integrated Health Associates, Michigan Orthopaedic Center, Ypsilanti, Michigan.
Notre Dame Seminary, Graduate School of Theology, Program of Priestly Formation, New Orleans, Louisiana.
J Wrist Surg. 2020 Apr;9(2):116-123. doi: 10.1055/s-0039-3400510. Epub 2019 Nov 26.
This article reviews the results of a surgical technique using three iterations of , autologous cancellous bone grafting ( ), and use of an intraosseous compression screw for the treatment of nondisplaced or minimally displaced scaphoid delayed unions or nonunions. Part 1-Cadaveric study: Three cadaveric scaphoids underwent stained cancellous bone graft packing and headless cannulated compression screw placement using a single iteration of drilling and graft packing. Three additional scaphoids were allocated to the triple "drill and fill" group, and underwent three iterations of drilling and graft packing before screw insertion. Graft particle distribution on mid-sagittal sections was assessed under fluorescence microscopy. Comparison of normalized areas between the single and triple "drill and fill" groups was performed using repeated measures ANOVA and Tukey's post hoc test. Part 2-Clinical study: Twelve patients with minimally displaced scaphoid delayed unions and nonunions treated between April 2007 and December 2013 with the triple "drill and fill" technique were included. The average follow-up was 60.4 weeks. Two fellowship-trained musculoskeletal radiologists independently reviewed images for fracture healing. By the histomorphometric analysis, there was improved autograft distribution along the screw tract, particularly within the proximal pole, with three iterations of drilling and filling. Clinically, 11 of 12 delayed unions and nonunions had healed. Our results support the use of the "drill and fill" technique as an option for the treatment of select nondisplaced or minimally displaced scaphoid nonunions and delayed unions at the waist without avascular necrosis of the proximal pole. This is a Level IV study.
本文回顾了一种手术技术的结果，该技术采用三次迭代的[具体技术名称未给出]、自体松质骨移植，并使用骨内加压螺钉治疗无移位或轻度移位的舟状骨延迟愈合或不愈合。 第1部分——尸体研究：对三个尸体舟状骨进行染色松质骨移植填充，并使用单次钻孔和移植填充进行无头空心加压螺钉置入。另外三个舟状骨被分配到三重“钻孔和填充”组，并在螺钉插入前进行三次钻孔和移植填充迭代。在荧光显微镜下评估矢状中面上的移植颗粒分布。使用重复测量方差分析和Tukey事后检验对单次和三重“钻孔和填充”组之间的标准化面积进行比较。第2部分——临床研究：纳入了2007年4月至2013年12月期间用三重“钻孔和填充”技术治疗的12例轻度移位的舟状骨延迟愈合和不愈合患者。平均随访时间为60.4周。两名接受过专科培训的肌肉骨骼放射科医生独立复查骨折愈合的图像。 通过组织形态计量分析，经过三次钻孔和填充迭代，自体移植物沿螺钉通道的分布得到改善，尤其是在近端极内。临床上，12例延迟愈合和不愈合中有11例已愈合。 我们的结果支持使用“钻孔和填充”技术作为治疗特定的无移位或轻度移位的舟状骨腰部不愈合和延迟愈合且近端极无缺血性坏死的一种选择。 这是一项IV级研究。
