From the Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong-si.
Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University School of Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea.
Ann Plast Surg. 2024 Feb 1;92(2):186-193. doi: 10.1097/SAP.0000000000003751. Epub 2023 Nov 24.
Bone grafting in patients with scaphoid waist nonunion can present several technical challenges. In this study, we aimed to present a modified surgical technique for scaphoid waist nonunion, which consisted of subchondral radial and ulnar K-wires positions with cancellous bone graft, and to compare the clinical outcome of this modified technique with the conventional method.
We retrospectively reviewed 72 patients with scaphoid waist nonunion who had been surgically treated between January 2011 and December 2020. Of these, 34 patients were treated with the modified method and 38 with the conventional method. Debridement of the nonunion site was performed using a curette, rongeur, and microburr. Two or 3 K-wires were inserted along the cancellous portion of the scaphoid in the conventional method. In the modified method, 2 K-wires were inserted along the ulnar and radial subchondral portion of the scaphoid to increase the space for bone grafting in the cancellous portion of the scaphoid. The autologous cancellous bone grafted in both the methods. Demographic, radiological, and clinical outcomes were reviewed and compared between the groups.
There were no significant differences in demographics and characteristics of nonunion between the 2 groups of patients. The modified method group showed significantly shorter union time than the conventional method group (conventional group: 13.0 ± 1.3 weeks, modified group: 11.4 ± 1.1 weeks; P < 0.001). The bony union rate was 97.1% for the modified method and 89.5% for the conventional method. Satisfactory clinical outcomes (excellent and good Mayo wrist scores) were achieved in 27 cases (81.8%) using the modified method and 22 cases (64.7%) using the conventional method.
Subchondral radial and ulnar K-wire positioning with cancellous bone graft (modified method) can improve the union time with satisfactory clinical outcomes in the treatment of scaphoid waist nonunion.
对于舟状骨腰部骨不连的患者，植骨术可能会带来一些技术挑战。在本研究中，我们旨在提出一种改良的舟状骨腰部骨不连手术技术，该技术包括软骨下桡骨和尺骨 K 型钉位置的植骨，并将这种改良技术的临床结果与常规方法进行比较。
我们回顾性分析了 2011 年 1 月至 2020 年 12 月期间接受手术治疗的 72 例舟状骨腰部骨不连患者。其中，34 例患者采用改良方法治疗，38 例患者采用常规方法治疗。使用刮匙、咬骨钳和微磨钻对骨不连部位进行清创。常规方法中，在舟状骨的松质骨部分插入 2 或 3 根 K 型钉。改良方法中，在舟状骨软骨下的桡骨和尺骨部分插入 2 根 K 型钉，以增加舟状骨的松质骨部分的植骨空间。两种方法均使用自体松质骨植骨。比较两组患者的人口统计学、影像学和临床结果。
两组患者在人口统计学和骨不连特征方面无显著差异。改良方法组的愈合时间明显短于常规方法组（常规组：13.0±1.3 周，改良组：11.4±1.1 周；P<0.001）。改良方法组的骨性愈合率为 97.1%，常规方法组为 89.5%。改良方法组 27 例（81.8%）和常规方法组 22 例（64.7%）获得了满意的临床结果（改良方法组和常规方法组的 Mayo 腕关节评分均为优秀和良好）。
软骨下桡骨和尺骨 K 型钉定位植骨（改良方法）可缩短愈合时间，获得满意的临床结果，是治疗舟状骨腰部骨不连的一种有效方法。
