Department of Orthopaedic Surgery, Catholic-Kwandong University, Incheon, South Korea.
Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
BMC Musculoskelet Disord. 2024 Jan 2;25(1):20. doi: 10.1186/s12891-023-07134-x.
Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques.
From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively.
Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups.
Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function.
Level III.
对于具有活近端干骺端的不稳定舟状骨骨不连，髂嵴皮质松质骨移植是可接受的治疗方法。然而，从髂嵴取移植物与供体部位发病率和全身麻醉的需要有关。因此，桡骨远端前外侧干骺端（DR）的骨移植可以作为一种治疗选择。然而，尚无研究比较两种植骨技术的临床效果。
2014 年至 2019 年，接受不稳定舟状骨骨不连伴驼峰畸形的患者接受桡骨远端前外侧干骺端（DR 组）或髂嵴（IC 组）皮质松质骨移植。术前 X 线和 CT 扫描评估后，通过测量舟月骨角（SLA）≥60°、舟骨内倾角（ISA）≥45°和桡月角（RLA）≥15°来确定驼峰畸形。SLA、ISA 和 RLA 用于评估腕骨排列。术后评估手术时间、握力、主动活动范围（ROM）、改良 Mayo 腕关节评分（MMWS）和上肢残疾问卷（DASH）评分。
38 名患者符合研究条件（DR 组 15 名；IC 组 23 名）。根据患者亚组，两组的愈合率无差异（DR 组 100%；IC 组 95.7%；P=0.827），末次随访时两组的握力、ROM、MWS 和 DASH 评分相似。DR 组的手术时间（分钟）明显短于 IC 组（中位数 98；四分位距 80，114）（P<0.001）。两组术后 ISA、RLA 和 SLA 均得到改善（P<0.001）。两组 SLA 评估的腕骨排列恢复程度，DR 组的矫正能力明显更强（中位数 25.3%，四分位距 21.1，35.3，P<0.05）。两组供体部位并发症无显著差异。
不稳定舟状骨骨不连的桡骨远端前外侧干骺端皮质松质骨移植与髂嵴相比，手术时间更短，在愈合、腕骨排列恢复和腕关节功能方面的结果相似。
III 级。
