Delamarre Morgane, Leroy Maxime, Barbarin Maxime, Chantelot Christophe, Saab Marc
Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France.
Statistics, Economic Evaluation, Data-Management (SEED), CHU Lille, 59037, Lille Cedex, France.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):507-515. doi: 10.1007/s00590-023-03687-8. Epub 2023 Aug 28.
Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors.
Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported.
This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5-20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN.
With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics.
Retrospective cohort study.
舟骨不愈合的治疗仍存在争议，主要基于带血管蒂或不带血管蒂的骨移植。本研究旨在通过长期随访评估功能、临床和影像学结果、报告的并发症和再次手术情况，并研究不愈合治疗的预后因素。
对接受舟骨不愈合骨移植手术的患者进行回顾性分析。评估的结果包括疼痛、qDASH、PRWE和MWS评分、主动活动范围、握力、愈合率、舟月角、腕骨高度和关节病情况。还报告了并发症和再次干预情况。
本研究纳入60例舟骨不愈合治疗病例，平均随访7.7（1.5 - 20.3）年。20例（33.3%）不愈合位于近端极，其中6例（10%）术前存在缺血性坏死（AVN）。51例患者（85%）实现愈合。功能、临床和影像学结果良好。并发症发生率为21.3%，再次干预率为16.7%。亚组愈合率分析发现，无论不愈合位于近端极还是存在AVN，愈合率均无差异。
通过具有代表性的样本和长期随访，我们发现无论选择何种治疗方法，愈合率、临床和功能结果均良好。舟骨不愈合的治疗仍存在争议，需要更多研究以根据患者和不愈合特征准确确定每种移植的适应证。
证据级别IV：回顾性队列研究。
