Könneker Sören, Schächinger Ulrich, Vogt Peter M
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Rämistr. 100, 8091, Zurich, Switzerland.
World J Surg. 2023 May;47(5):1129-1135. doi: 10.1007/s00268-023-06937-2. Epub 2023 Feb 11.
Magnesium-based bioabsorbable osteosynthesis material continues to receive increasing attention. The following study documents our experience with bioabsorbable magnesium screws in scaphoid fracture treatment in hopes to capture further evidence and successful application.
Eight acute scaphoid fractures and four nonunions were treated with the magnesium-based bioabsorbable compression screw MAGNEZIX. Objective outcome was assessed by X-ray imaging and/or CT scan for bone healing. Clinical assessment was achieved using the modified Mayo Wrist Score. Patient-reported outcome measure was performed threefold via QuickDASH, PRWE, and EQ-5D-5L questionnaires in all patients. Follow-up was 32.5 months (SD 18.7) in the acute fracture group and 31 months (SD 7.4) in the nonunion group.
Bone healing was achieved in all eight patients with acute scaphoid fractures and in three of four patients with scaphoid nonunion. The modified Mayo Wrist Score was 95 (SD 7.1) in fractures and 80 (SD 7.1) in nonunion patients during follow-up. QuickDASH score was 3.9 (SD 5.8) in fracture and 19.3 (SD 10.6) in nonunion patients. All but one patient (87,5%) with scaphoid fractures presented with a full health state during follow-up (EQ-5D-5L). Nonunion patients had problems in 10 out of 19 dimensions in EQ-5D-5L. Acute fractures presented with a score of 3.9 (SD 7.9) and nonunions with a score of 19.7 (SD 32.4) in PRWE total scoring during follow-up.
Magnesium-based implants have excellent clinical outcomes when used for scaphoid fractures in eight presented cases and good to moderate clinical outcomes when used for nonunions in three of four presented cases. Additional studies are required to further analyze the differentiated applicability in scaphoid nonunion as well as overall performance when compared to non-absorbable screws in larger cohorts.
镁基生物可吸收接骨材料受到越来越多的关注。以下研究记录了我们使用生物可吸收镁螺钉治疗舟骨骨折的经验，以期获取更多证据并实现成功应用。
使用镁基生物可吸收加压螺钉MAGNEZIX治疗8例急性舟骨骨折和4例骨不连。通过X线成像和/或CT扫描评估骨愈合的客观结果。使用改良的梅奥腕关节评分进行临床评估。所有患者均通过QuickDASH、PRWE和EQ-5D-5L问卷进行三次患者报告结局测量。急性骨折组的随访时间为32.5个月（标准差18.7），骨不连组为31个月（标准差7.4）。
8例急性舟骨骨折患者全部实现骨愈合，4例舟骨骨不连患者中有3例实现骨愈合。随访期间，骨折患者的改良梅奥腕关节评分为9分（标准差7.1），骨不连患者为80分（标准差7.1）。骨折患者的QuickDASH评分为3.9（标准差5.8），骨不连患者为19.3（标准差10.6）。除1例患者（87.5%）外，所有舟骨骨折患者在随访期间均处于完全健康状态（EQ-5D-5L）。骨不连患者在EQ-5D-5L的19个维度中有10个存在问题。随访期间，急性骨折患者的PRWE总评分为3.9（标准差7.9），骨不连患者为19.7（标准差32.4）。
在本研究的8例病例中，镁基植入物用于舟骨骨折时具有优异的临床效果，在4例病例中的3例用于骨不连时具有良好至中等的临床效果。与不可吸收螺钉相比，在更大的队列中，需要进一步研究以分析其在舟骨骨不连中的差异化适用性以及整体性能。
