Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea.
Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Int Orthop. 2024 Feb;48(2):487-493. doi: 10.1007/s00264-023-05998-1. Epub 2023 Oct 5.
Cancellous bone harvested from the distal radius has been used in various hand surgeries, but studies on its use in scaphoid waist nonunions are insufficient. We investigated the usefulness of cancellous bone graft from the distal radius and headless screw fixation in unstable scaphoid waist nonunion.
Thirty-one patients who underwent cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion with follow-up for at least 1 year were included. Bone union time, the number of patients with bone union at six and 12 weeks, total number of patients with bone union at last follow-up, and bone union on the computed tomography (CT) image at postoperative six weeks were evaluated. Further, pre- and postoperative radiological measurements, such as scaphoid length and height, lateral intra-scaphoid angle, and height-to-length ratio, and functional outcomes were compared. Additionally, inter-observer reliability of radiologic parameters was checked.
Bone union was achieved in 29 patients. There were two nonunions (6.5%). Bone union time was 10.7 (range, 6-26) weeks. Eighteen (58%) and 25 patients (80.6%) were diagnosed with bone union on the plain radiographs at six and 12 weeks, respectively. Twenty-two patients (71%) were diagnosed with bone union on CT performed at six weeks. Radiological measurements and functional outcomes improved postoperatively. The scaphoid length showed good inter-observer agreement.
In treating unstable scaphoid waist nonunion, cancellous bone graft from the distal radius and headless screw fixation achieved 93.5% union and improved radiological measurements as well as functional outcomes.
取自桡骨远端的松质骨已被用于各种手部手术中，但有关其在舟状骨腰部骨不连中的应用的研究还不够充分。我们研究了取自桡骨远端的松质骨移植物和无头螺钉固定在不稳定的舟状骨腰部骨不连中的作用。
我们纳入了 31 例接受取自桡骨远端的松质骨移植物和无头螺钉固定治疗不稳定的舟状骨腰部骨不连的患者，这些患者的随访时间至少为 1 年。评估了骨愈合时间、6 周和 12 周时骨愈合的患者数量、末次随访时所有患者的总愈合数量以及术后 6 周 CT 图像上的骨愈合情况。此外，还比较了术前和术后的影像学测量值，如舟骨长度和高度、外侧舟骨内角度和高度与长度比，以及功能结果。另外，还检查了影像学参数的观察者间可靠性。
29 例患者实现了骨愈合。有 2 例（6.5%）发生骨不连。骨愈合时间为 10.7（范围，6-26）周。18 例（58%）和 25 例（80.6%）患者分别在 6 周和 12 周时的 X 线片上诊断为骨愈合。22 例（71%）患者在 6 周时的 CT 上诊断为骨愈合。影像学测量值和功能结果在术后均得到改善。舟骨长度的观察者间一致性较好。
在治疗不稳定的舟状骨腰部骨不连时，取自桡骨远端的松质骨移植物和无头螺钉固定的方法可实现 93.5%的愈合率，并改善影像学测量值和功能结果。
