Testa Gianluca, Lucenti Ludovico, D'Amato Salvatore, Sorrentino Marco, Cosentino Pierluigi, Vescio Andrea, Pavone Vito
Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.
J Clin Med. 2022 Jun 14;11(12):3402. doi: 10.3390/jcm11123402.
Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts.
A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included.
A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above.
The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon's knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases.
舟骨骨折占所有腕骨骨折的60%，有10%发展为骨不连的风险。此外，约3%会出现近端极的缺血性坏死（AVN），这是与该骨特殊血管化相关的主要并发症之一。舟骨骨不连可采用带血管和不带血管的骨移植治疗。本研究的目的是评估使用两种类型的移植治疗舟骨骨不连的愈合率。
由两名独立作者对两个电子医学数据库进行系统评价，采用以下纳入标准：舟骨近端极骨不连，采用带血管骨移植（VBG）或不带血管骨移植（NVBG）治疗，使用或不使用内固定，年龄≥10岁的患者，以及至少12个月的随访。纳入任何报告临床结果且关于使用带血管或不带血管骨移植治疗舟骨骨不连的证据水平的研究。
共识别出271篇文章。在首次筛选结束时，选择了104篇符合条件的文章进行全文阅读。最后，在阅读文本并对照参考文献列表后，我们按照上述标准选择了26篇文章。
VBG的选择主要取决于舟骨的缺损情况以及外科医生对不同技术的了解。在困难病例中，带内侧股骨髁（MFC）的游离血管移植似乎是局部带血管骨移植的一种有前景的替代方法。
