锁定钢板治疗伴有严重骨缺损的舟状骨骨不连:病例系列研究。

Locking plate osteosynthesis of scaphoid nonunion with severe bone defects: a case series.

机构信息

Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Department of Orthopedics and Trauma Surgery, Hopitaux Robert Schuman, 9, rue Edward Steichen, 2540, Luxembourg, Luxembourg.

出版信息

Sci Rep. 2022 May 19;12(1):8379. doi: 10.1038/s41598-022-12305-2.

Abstract

The treatment of scaphoid nonunion can be challenging with increasing defect size. We evaluated the outcome of scaphoid nonunion with a substantial bone defect treated with a multidirectional locking plate combined with cancellous bone grafting only. Thirteen patients with significant osseous defects measuring 6 mm or more suffering from primary nonunion without treatment (n = 6) or recalcitrant nonunion following Herbert screw osteosynthesis (n = 7) were treated and reviewed retrospectively. The stabilization was performed after debridement, autologous cancellous bone grafting and volar locking plate osteosynthesis. After a mean follow-up period of 12 months, 12 of the 13 patients achieved successful unions with a free range of motion and complete remittance of pain in everyday activity. The mean scapholunate angle decreased from 59.7° ± 11 to 43.9° ± 5 (effect strength d:1.7, p < 0.00001), scaphoid humpback deformity angle from 58.9° ± 8 to 45.1° ± 8 (d:1.8, p < 0.0001), whereas strength of the injured hand increased from 36.4 kg ± 10 to 42.4 kg ± 9 (d:1.4, p < 0.0001). One nonunion persisted without fragment dislocation receiving revision after 1 year. Thus, locking plate osteosynthesis with cancellous bone grafting is a valid alternative in scaphoid nonunions with extensive bone defects. Additionally, stable retention of the fragments prevents dislocation even in delayed or persistent nonunion. Further prospective studies are required to confirm these findings.

摘要

舟状骨骨不连的治疗具有挑战性,尤其是骨缺损较大时。我们评估了单纯使用多向锁定钢板结合松质骨植骨治疗有较大骨缺损的舟状骨骨不连的结果。 13 例原发性骨不连(未经治疗 6 例,Herbert 螺钉固定后再发骨不连 7 例)患者,骨缺损达 6mm 或以上,伴显著的骨缺损,接受了清创、自体松质骨植骨和掌侧锁定钢板内固定治疗,并进行了回顾性研究。平均随访 12 个月后,13 例患者中的 12 例获得了成功愈合,活动度完全恢复,日常活动中疼痛完全缓解。平均舟月角从 59.7°±11 减少到 43.9°±5(效应强度 d:1.7,p<0.00001),舟状骨驼背畸形角从 58.9°±8 减少到 45.1°±8(d:1.8,p<0.0001),受伤手的握力从 36.4kg±10 增加到 42.4kg±9(d:1.4,p<0.0001)。1 例非愈合患者未出现骨折块移位,1 年后接受翻修。因此,对于广泛骨缺损的舟状骨骨不连,锁定钢板内固定结合松质骨植骨是一种有效的治疗方法。此外,即使在延迟或持续不愈合时,骨折块的稳定固定也能防止其移位。需要进一步的前瞻性研究来证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5797/9120041/fac762629745/41598_2022_12305_Fig1_HTML.jpg

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