Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil.
Instituto Vita, São Paulo, SP, Brazil.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6955-6963. doi: 10.1007/s00402-023-05003-9. Epub 2023 Aug 1.
Scaphoid is the most fractured carpal bone, with a 5-10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing.
Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery.
Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation.
In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups.
Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B.
IV, case series.
舟骨是最常发生骨折的腕骨，其不愈合率为 5-10%。治疗的挑战包括选择最佳的植入物和移植物，以纠正驼峰畸形和腕骨对线不良，并提高骨愈合的机会。
比较使用锁定板治疗舟骨不愈合的两组患者中皮质-松质骨和松质骨移植物的疗效，评估两组患者在术前和术后的骨愈合率以及影像学、断层扫描和功能参数。
这是一项非随机前瞻性研究，共纳入 20 例舟骨不愈合患者。将患者分为 A 组（10 例患者采用髂骨皮质-松质骨移植物治疗）和 B 组（10 例患者采用髂骨松质骨移植物治疗）。患者均接受术前和术后的 X 线片、计算机断层扫描和功能评估。
在术后分析中，A 组患者的舟骨内角度（p=0.002）和舟月角（p=0.011）在术前和术后均有显著差异。B 组患者的舟骨内角度（p=0.002）和舟月角矫正（p=0.0018）、握力（p=0.002）和指尖捏力（p=0.001）在术前和术后均有显著差异。将两组进行比较，B 组患者的舟骨内角度矫正（p=0.002）、握力（p=0.002）、指尖捏力（p=0.002）和桡偏（p=0.0003）有显著差异。两组患者的骨愈合率无统计学差异。
使用锁定板治疗舟骨不愈合效果良好，两种移植物类型均具有较高的骨愈合率和改善的腕骨对线。然而，B 组患者的舟骨内角度矫正、握力、指尖捏力和桡偏的结果更好。
IV，病例系列。
