ICATMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
ICATMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
J Hand Surg Am. 2020 Oct;45(10):924-936. doi: 10.1016/j.jhsa.2020.06.013. Epub 2020 Aug 6.
To evaluate clinical and radiological outcomes after surgical treatment of difficult scaphoid nonunion in adults with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF).
Thirty-two patients at least 18 years old, with scaphoid nonunion and characteristics associated with a poor prognosis, who underwent a VTMPF procedure, were included in this retrospective cohort study with a mean follow-up of 17 months. Factors associated with a poor prognosis were a delay in presentation of over 5 years, the presence of avascular necrosis, and previous nonunion surgery. All patients had at least 1 poor prognostic factor and 25% had 2 or more.
In 30 men and 2 women, the mean age was 36 years (range, 19-56 years). There were 11 type D3 nonunions (Herbert classification) and 15 type D4. Five patients had delayed presentation of over 5 years. Fourteen patients had previously undergone an unsuccessful surgical attempt to treat their nonunion. The patients experienced no postoperative complications. Overall union rate was 97% (31 of 32 patients), with 72% cross-sectional trabecular percentage bridging at 12 weeks. Pain subsided after surgery and patients experienced improvements in both their Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Modified Mayo Wrist Score (MMWS). Overall 41% and 42% gains in strength and wrist motion, relative to the contralateral normal side, were observed. At final follow-up, there were no differences between the treated and the untreated (healthy) hands, in terms of wrist range of motion, grip, or pinch strength.
In this study, the use of VTMPF for difficult scaphoid nonunion in adults was associated with good general outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估成人难愈合性舟状骨骨不连患者采用带血管蒂的拇指掌骨骨膜瓣（VTMPF）手术治疗的临床和影像学结果。
本回顾性队列研究共纳入 32 例至少 18 岁的患者，这些患者均存在舟状骨骨不连且具有预后不良特征，他们接受了 VTMPF 手术治疗，平均随访 17 个月。预后不良的相关因素包括：就诊时间超过 5 年，存在缺血性坏死，以及既往非愈合手术史。所有患者至少存在 1 个预后不良因素，25%的患者存在 2 个或更多。
30 例男性和 2 例女性患者的平均年龄为 36 岁（范围 19-56 岁）。11 例（Herbert 分型）为 D3 型非愈合，15 例为 D4 型。5 例患者就诊时间超过 5 年。14 例患者既往曾接受过治疗非愈合的手术尝试，但未成功。患者术后无并发症发生。总体愈合率为 97%（31/32 例），12 周时的横截面积骨小梁百分比桥接率为 72%。术后疼痛缓解，患者的手臂、肩和手的快速残疾（QuickDASH）和改良 Mayo 腕关节评分（MMWS）均得到改善。与健侧相比，握力和腕关节活动度分别平均提高了 41%和 42%。末次随访时，患侧与健侧（正常）手的腕关节活动度、握力或捏力无差异。
在本研究中，对于成人难愈合性舟状骨骨不连，采用 VTMPF 治疗总体效果良好。
研究类型/证据水平：治疗性 IV 级。
