The Curtis National Hand Center, Baltimore, MD.
The Curtis National Hand Center, Baltimore, MD.
J Hand Surg Am. 2021 Sep;46(9):801-806.e2. doi: 10.1016/j.jhsa.2021.05.014. Epub 2021 Jun 26.
The decision regarding the use of vascularized bone grafting (VBG) or nonvascularized bone grafting for the treatment of scaphoid nonunion (SNU) needs guidelines based on patient- and fracture-specific risk factors. Historically, the presence of avascular necrosis was viewed as the primary indication for VBG; however, avascular necrosis is not the only indicator to determine whether VBG can improve our treatment of difficult SNU cases. The methods of detecting scaphoid avascular necrosis lack consensus and accuracy, limiting their use as decision-making tools. Additionally, many other preoperative risk factors for SNU surgery failure have been reported and require careful and standardized study, including the location of nonunion in the scaphoid proximal pole, the duration of nonunion, previous failed nonunion surgery, smoking, and fracture nonunion displacement or collapse. An appropriate study size and design are needed to determine the factors that guide the use of VBG or nonvascularized bone grafting to optimize the outcomes of SNU surgery.
对于治疗舟状骨骨不连 (SNU)，采用血管化骨移植 (VBG) 还是非血管化骨移植，需要根据患者和骨折的具体风险因素制定指南。从历史上看，存在缺血性坏死被视为 VBG 的主要指征；然而，缺血性坏死并不是唯一可以确定 VBG 是否能改善我们对困难 SNU 病例治疗效果的指标。检测舟状骨缺血性坏死的方法缺乏共识和准确性，限制了它们作为决策工具的使用。此外，已经报道了许多其他与 SNU 手术失败相关的术前危险因素，需要进行仔细和标准化的研究，包括：骨不连在舟状骨近极的位置、骨不连的持续时间、先前失败的骨不连手术、吸烟以及骨折不连移位或塌陷。需要有合适的研究规模和设计来确定指导 VBG 或非血管化骨移植使用的因素，以优化 SNU 手术的结果。
