Department of Orthopaedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan, ROC.
Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC.
J Orthop Surg Res. 2023 Feb 21;18(1):123. doi: 10.1186/s13018-023-03609-8.
This study was designed to analyze the clinical follow-up results (minimum of 2 years) in patients with stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis (Lichtman classification stage I-III) treated with arthroscopic osteosynthesis with autogenous bone graft.
We retrospectively recruited 44 consecutive patients with scaphoid fracture nonunion treated with arthroscopy-assisted percutaneous internal fixation with autogenous bone grafts from January 2010 to November 2019. We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean duration of 33 months (range 24-46 months). Clinical (i.e., visual analog scale pain score, grip strength, and range of motion), radiographic, and functional (Mayo Modified Wrist Score (MMWS)) outcomes at the final follow-up were compared with the preoperative assessments and analyzed in patients with different stages.
We confirmed union in 39 of the 44 patients (88.6%) after a mean 15.4 weeks post-operatively according to clinical examinations and standard radiography. All clinical parameters improved significantly. For the MMWS, there were 25 excellent and 14 good results. Of the 44 patients, 40 (90.9%) returned to work or sports activities at their preinjury levels. Comparisons of the outcomes between patients in different stages of scaphoid nonunion revealed no significant difference in the aspect of union rate, VAS pain score, and functional score improvement.
Arthroscopic osteosynthesis with autogenous bone grafts is a reliable and minimally invasive method for achieving nonunion healing and improving clinical outcomes in stage I-III scaphoid nonunion.
Level IV, case series.
本研究旨在分析采用关节镜下自体骨移植治疗稳定型、不稳定型或舟骨骨不连合并早期退行性舟月关节炎（Lichtman 分类 I-III 期）患者的临床随访结果（至少 2 年）。
我们回顾性招募了 2010 年 1 月至 2019 年 11 月期间采用关节镜辅助经皮内固定联合自体骨移植治疗舟骨骨折不愈合的 44 例连续患者。我们记录了愈合和恢复活动情况，并在平均 33 个月（24-46 个月）的定期临床随访中分析数据。在最后一次随访时，比较了临床（即视觉模拟评分疼痛、握力和活动范围）、影像学和功能（改良 Mayo 腕关节评分（MMWS））结果，并分析了不同分期患者的结果。
根据临床检查和标准影像学，我们在术后平均 15.4 周确认 44 例患者中的 39 例（88.6%）愈合。所有临床参数均显著改善。对于 MMWS，有 25 例为优秀，14 例为良好。44 例患者中，40 例（90.9%）恢复到受伤前的工作或运动水平。在不同分期的舟骨骨不连患者的结果比较中，愈合率、VAS 疼痛评分和功能评分改善方面无显著差异。
关节镜下自体骨移植是治疗 I-III 期舟骨骨不连的一种可靠、微创的方法，可实现骨愈合和改善临床结果。
IV 级，病例系列。
