Department of Hand Surgery, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, 518000, China.
J Orthop Surg Res. 2023 Jan 18;18(1):52. doi: 10.1186/s13018-023-03529-7.
The treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment.
This study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes.
It was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period.
Significant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients.
The arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.
不稳定的舟状骨骨折和不愈合仍然是手外科医生面临的挑战。微创治疗已成为首选的治疗方法。
本研究介绍了关节镜下双头加压螺钉（HCS）固定和桡骨远端植骨治疗不稳定舟状骨骨折和不愈合的技术，并评估其临床和影像学结果。
这是一项回顾性研究。2019 年 1 月至 2021 年 2 月，共纳入 23 例患者。其中，13 例不稳定舟状骨骨折患者行关节镜下双头加压螺钉治疗；10 例舟状骨不愈合患者行关节镜下双头加压螺钉和桡骨远端植骨治疗。术前和末次随访时测量腕关节活动度、视觉模拟评分（VAS）、握力、改良 Mayo 腕关节评分（MMWS）、患者报告的腕关节评分（PRWE）和上肢残疾指数（DASH）。每位患者均在随访期间行腕关节 CT 扫描，以评估愈合和术后骨关节炎情况。
仅在腕关节伸展时观察到显著改善。末次随访时，握力、VAS 疼痛评分、MMWS、PRWE 评分和 DASH 评分均显著改善。在亚组分析中，采用双头加压螺钉或桡骨远端植骨联合双头加压螺钉固定的患者，术后临床结果均得到改善。所有患者均获得愈合。无螺钉固定失败，无其他术后并发症发生。
关节镜下双头加压螺钉固定和桡骨远端植骨是治疗不稳定舟状骨骨折和不愈合的可靠、有效的方法，可获得满意的愈合率和临床结果。
