Okhovatpour Mohammad Ali, Zandi Reza, Ahmadi Abdashti Ahmadreza, Jafari Kafiabadi Meisam
Arch Bone Jt Surg. 2025;13(2):82-86. doi: 10.22038/ABJS.2024.79732.3644.
Non-repairable scaphoid proximal pole nonunion remains a major challenge. Various reconstructive surgical approaches have been introduced, but each one has some limitations, including microvascular anastomosis, donor site morbidities, and the risk of compromising the scapholunate ligament.
This prospective interventional case series was performed on five patients. The patients underwent reconstructive surgery using proximal hamate arthroplasty by a single surgeon and were followed up for at least 12 months.
All patients were male and the median age was 28, and the median follow-up time was 24 months. The median Mayo score was 70, and the DASH score was 0 (no disability) in 3 patients and 15 in two patients. The median of postoperative grip strength in the operated hands was 37.3 kg (Range 36.1-39) and in the opposite hands was 42.5 kg (Range 40-45.9). However, there were significant differences between grip strength between operated and opposite hands (P value= 0.008). A reduction of 11.1% and 15% was shown in postoperative flexion and extension compared with preoperative flexion and extension (P value = 0.194, P value = 0.102).
Hamate arthroplasty for nonunion of the scaphoid proximal pole appears to be a viable surgical option with favorable outcomes in terms of union rates, functional recovery, and patient satisfaction.
不可修复的舟骨近端极骨不连仍然是一项重大挑战。已经引入了各种重建手术方法，但每种方法都有一些局限性，包括微血管吻合、供区并发症以及损伤舟月韧带的风险。
对5例患者进行了这项前瞻性介入病例系列研究。患者由同一位外科医生采用近端钩骨成形术进行重建手术，并随访至少12个月。
所有患者均为男性，中位年龄为28岁，中位随访时间为24个月。梅奥评分中位数为70分，3例患者的DASH评分为0（无残疾），2例患者为15分。手术手术后握力中位数为37.3 kg（范围36.1 - 39），对侧手为42.5 kg（范围40 - 45.9）。然而，手术手与对侧手握力之间存在显著差异（P值 = 0.008）。与术前屈伸相比，术后屈伸分别降低了11.1%和15%（P值 = 0.194，P值 = 0.102）。
对于舟骨近端极骨不连，钩骨成形术似乎是一种可行的手术选择，在骨愈合率、功能恢复和患者满意度方面具有良好的效果。
