关节镜下尺骨茎突骨块移植和螺钉固定治疗舟状骨骨不连可实现愈合并改善结局。

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes.

机构信息

Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

出版信息

Arthroscopy. 2022 Mar;38(3):761-772. doi: 10.1016/j.arthro.2021.09.018. Epub 2021 Sep 25.

DOI:10.1016/j.arthro.2021.09.018

PMID:34571185

Abstract

PURPOSE

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion.

METHODS

Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed.

RESULTS

Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P = .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P = .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P = .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P = .014).

CONCLUSIONS

Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

评估尺骨骨突骨移植和螺钉固定治疗舟状骨不愈合的效果，并根据慢性、位置和不愈合严重程度的变化分析结果。

方法

2012 年 3 月至 2020 年 12 月，对诊断为舟状骨延迟不愈合和伴有大量骨吸收的不愈合（Slade 和 Dodds 分级 IV-VI）的患者进行关节镜辅助下尺骨突骨移植和螺钉固定。术前和术后的测量指标包括疼痛视觉模拟量表评分；活动范围；握力；改良 Mayo 腕关节评分；上肢残疾问卷（DASH）评分；以及 DASH 评分的最小临床重要差异。还评估了愈合率和愈合时间。分析了不同病情患者组之间的结果。

结果

共纳入 22 例患者。平均随访时间为 32.5 个月。术后疼痛视觉模拟量表评分、活动范围、握力、改良 Mayo 腕关节评分和 DASH 评分均显著改善（P<0.001）。DASH 评分的最小临床重要差异阈值为 100%的患者达到。末次随访时，所有患者的舟骨均愈合，无并发症。平均愈合时间为 15.3 周。组间分析显示，延迟愈合（3-6 个月）与慢性不愈合（>1 年）患者之间的平均握力有显著改善（17.75kg 比 12.25kg，P=0.032），IV 级不愈合与 V 级不愈合之间（14.86kg 比 10.43kg，P=0.035），V 级不愈合与 VI 级不愈合之间（10.43kg 比 15.63kg，P=0.013）。VI 级不愈合患者术后 17.8 周达到愈合，明显长于 IV 级不愈合患者（11.4 周，P=0.014）。