Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
BMC Musculoskelet Disord. 2020 Dec 10;21(1):834. doi: 10.1186/s12891-020-03850-w.
There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint.
Between 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain.
Nineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24-120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5 to 67.4, wrist extension from 62.3 to 71.7, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82 to 66. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups.
Using arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.
治疗舟状骨近段骨不连存在一定困难，主要包括舟状骨近段骨折块血供较差以及舟状骨近段骨折块内固定稳定空间有限。本研究报告了关节镜辅助复位、植骨和穿过舟月（SL）关节螺钉固定治疗舟状骨近段骨不连的结果。
2008 年至 2017 年，共纳入 21 例患者。评估骨折愈合情况及 SL 外侧角和 SL 间隙的变化。采用上肢功能障碍评定量表（DASH）评分、腕关节活动度、握力和疼痛视觉模拟评分（VAS）评估功能结果。
19 例患者骨折愈合，平均随访时间为 31.3 个月（24-120 个月）。骨折愈合时间平均为 16.3 周（10-28 周）。从术前到术后最终评估，腕关节功能有一定程度的改善，包括腕关节屈曲从 54.5°增加至 67.4°，腕关节伸展从 62.3°增加至 71.7°，DASH 评分从 52.4 分降至 21.4 分，活动时 VAS 评分从 4.6 分降至 2.1 分，握力从 9.6kg 增加至 24.7kg。SL 外侧角也明显改善，从 82°降至 66.7°。17 例患者在骨折愈合后因文化信仰而要求取出内固定螺钉，因为他们认为体内不应留有金属植入物。在后续的连续随访中，螺钉取出后 SL 间隙未见明显增宽。
关节镜辅助复位、植骨和穿过 SL 关节螺钉固定治疗舟状骨近段骨不连，可获得满意的功能和影像学结果。
