Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Unit of Orthopedics and Traumatology 2, Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy.
J Hand Surg Asian Pac Vol. 2022 Aug;27(4):615-622. doi: 10.1142/S2424835522500588. Epub 2022 Aug 8.
Subacute proximal pole scaphoid fractures (1 month to 6 months) have a higher risk of non-union. The aim of the present retrospective analysis is to evaluate the efficacy of gelled platelet-rich plasma (GPRP) as additional treatment to antegrade headless screw fixation of proximal pole scaphoid fractures. Forty-one patients were divided into two groups based on surgical treatment received: screw fixation alone (group A) and screw fixation and GPRP application at the fracture site (group B). A short cast was maintained for 4 weeks after surgery. Outcome measures included time to union, need for additional procedures, time to return to work, disabilities of the arm, shoulder, and hand (DASH) questionnaire, Michigan Hand Questionnaire (MHQ) and Mayo wrist score (MWS).Time to union was determined by monthly radiographs and confirmed by a computerized tomographic (CT) scan done at 4 months. Union was achieved in 85.7% of patients in group A and in 100% of patients in group B. Patients in group B showed a faster time to healing (2.3 ± 0.4 months vs 3.1 ± 0.7 months, = 0.0001) and earlier return to work (10.4 ± 2.2 vs 15.1 ± 2.9, = 0.0001). There were no significant differences in patient-rated outcomes scores between the two groups at final follow-up. Internal fixation alone is effective in treating subacute proximal pole scaphoid fractures. GPRP application improves bone healing and functional recovery. Level III (Therapeutic).
亚急性近极舟状骨骨折（1 个月至 6 个月）的不愈合风险较高。本回顾性分析旨在评估凝胶化富血小板血浆（GPRP）作为近极舟状骨骨折顺行无头螺钉固定的附加治疗的疗效。41 例患者根据手术治疗分为两组：单纯螺钉固定（A 组）和螺钉固定加骨折部位 GPRP 应用（B 组）。术后用短石膏固定 4 周。评估指标包括愈合时间、是否需要额外手术、恢复工作时间、上肢功能障碍（DASH）问卷、密歇根手问卷（MHQ）和 Mayo 腕关节评分（MWS）。通过每月的 X 线片确定愈合时间，并在 4 个月时通过计算机断层扫描（CT）确认。A 组 85.7%的患者和 B 组 100%的患者达到愈合。B 组患者的愈合时间更快（2.3±0.4 个月比 3.1±0.7 个月，=0.0001），恢复工作的时间更早（10.4±2.2 个月比 15.1±2.9 个月，=0.0001）。在最终随访时，两组患者的主观评分无显著差异。单纯内固定治疗亚急性近极舟状骨骨折有效。GPRP 应用可促进骨折愈合和功能恢复。III 级（治疗）。
