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舟骨假关节的关节镜治疗:技术描述与病例系列

Arthroscopy Treatment of Scaphoid Pseudarthrosis: Description of the Technique and Case Series.

作者信息

Kaempf Ricardo, Brunelli João, Bayer Leohnard, Aita Márcio, Schneider Santhiago Pereira, Delgado Pedro J

机构信息

Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.

Faculdade de Medicina do ABC, Santo André, SP, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2024 Jan 29;59(5):e719-e729. doi: 10.1055/s-0043-1770969. eCollection 2024 Oct.

Abstract

To describe the procedure and evaluate the results of a series of patients with stable and unstable pseudarthrosis of the scaphoids treated with the use of arthroscopy associated with cancellous bone graft and compression screw.  Twenty-three patients were treated with this technique. The minimum postoperative follow-up was 12 months, and pre- and postoperative functional, clinical, and imaging analyses were performed.  Themean time from fracture to surgery was 26 months (12-60). Preoperative and postoperative clinical and radiological parameters were analyzed. The mean follow-up was 24.2 (12-60) months. Consolidation occurred in 22 patients (95.6%) in an average of 7.5 (4-12) weeks. Mean flexion range ofmotion improved from73.6° (60-80°) to 79.5° (60-90°); the range from 68.6° (50-80°) to 71.9° (45-85°); ulnar deviation from 20.6° (15-30°) to 26.9° (20-35°); and the radial deviation from 17.3° (15-25°) to 20.4° (10-25°). Pain (Visual Analog Scale [VAS] 0-10) improved from 7.3 (4-9) to 0.7 (0-6) and DASH functional scale improved from 49 (32-75) to 6 (2-12). The scapholunate angle improved from 69.1° (55-85°) to 48.4° (40-55°) and the radiolunar angle improved from 30° (10-40°) to 2.6° (0-8°).  Treatment of stable and unstable pseudarthrosis of the scaphoid with spongy bone graft and percutaneous internal fixation, preferably with a headless compression screw, assisted by arthroscopy, showed good clinical and radiographic results in our series, with a short time for consolidation and functional recovery.

摘要

描述使用关节镜联合松质骨移植和加压螺钉治疗舟骨稳定和不稳定假关节的一系列患者的手术过程并评估结果。23例患者接受了该技术治疗。术后最短随访时间为12个月,并进行了术前和术后的功能、临床及影像学分析。骨折至手术的平均时间为26个月(12 - 60个月)。分析术前和术后的临床及放射学参数。平均随访时间为24.2个月(12 - 60个月)。22例患者(95.6%)实现愈合,平均时间为7.5周(4 - 12周)。平均屈曲活动范围从73.6°(60 - 80°)改善至79.5°(60 - 90°);伸展活动范围从68.6°(50 - 80°)改善至71.9°(45 - 85°);尺偏从20.6°(15 - 30°)改善至26.9°(20 - 35°);桡偏从17.3°(15 - 25°)改善至20.4°(10 - 25°)。疼痛(视觉模拟评分[VAS]0 - 10)从7.3(4 - 9)改善至0.7(0 - 6),DASH功能评分从49(32 - 75)改善至6(2 - 12)。舟月角从69.1°(55 - 85°)改善至48.4°(40 - 55°),桡月角从30°(10 - 40°)改善至2.6°(0 - 8°)。在我们的系列研究中,关节镜辅助下采用松质骨移植和经皮内固定(最好使用无头加压螺钉)治疗舟骨稳定和不稳定假关节,显示出良好的临床和影像学结果,愈合时间短且功能恢复良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c726/11624938/5693c4ec7cc0/10-1055-s-0043-1770969-i2200077en-1.jpg

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