Wirth Michael A, Maniglio Mauro, Jochum Benedikt C, Mania Sylvano, Nagy Ladislav, Schweizer Andreas, Reissner Lisa
Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
Department of Hand Surgery, Kantonsspital St. Gallen (KSSG), Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
J Clin Med. 2025 Mar 19;14(6):2082. doi: 10.3390/jcm14062082.
Scaphoid reconstruction after an established non- or malunion is challenging and recent developments have shown the feasibility to reconstruct it with 3D-planned and -printed patient-specific instrumentation. Our study compared the clinical outcome of computer assisted 3D-reconstructions of the scaphoid using patient-specific guides for primary and revision reconstructions of scaphoid nonunion regarding clinical outcome. Therefore, 39 patients with primary scaphoid nonunion or malunion and 15 patients with nonunion or malunion after a previous operative treatment were treated with patient-specific guides and followed up for a mean of 10.5 months. The consolidation was assessed with a CT-scan, and the time to consolidation was recorded. Pain level, satisfaction, wrist range of motion, and grip strength were measured and compared. The wrist range of motion and grip strength of the two groups were similar, except for the wrist extension, which was significantly reduced in the revision group. Consolidation was observed in 36/39 patients (92%) in the primary group and in 13/15 patients (87%) in the revision group. Our results showed similar clinical results postoperatively between primary reconstructions and revision surgery. The use of 3D-planned and -printed patient-specific instrumentation proves to be similarly effective in revision surgeries for the reconstruction of the scaphoid as it is in primary surgeries.
对于已形成的骨不连或畸形愈合后的舟状骨重建具有挑战性，而最近的进展表明，使用三维规划和打印的患者特异性器械进行重建是可行的。我们的研究比较了使用患者特异性导向器对舟状骨骨不连进行初次和翻修重建的计算机辅助三维重建舟状骨的临床结果。因此，39例初次舟状骨骨不连或畸形愈合患者和15例先前手术治疗后发生骨不连或畸形愈合的患者接受了患者特异性导向器治疗，并平均随访10.5个月。通过CT扫描评估骨愈合情况，并记录骨愈合时间。测量并比较疼痛程度、满意度、腕关节活动范围和握力。两组的腕关节活动范围和握力相似，但翻修组的腕关节伸展明显减少。初次组39例患者中有36例（92%）观察到骨愈合，翻修组15例患者中有13例（87%）观察到骨愈合。我们的结果显示，初次重建和翻修手术术后的临床结果相似。事实证明，使用三维规划和打印的患者特异性器械进行舟状骨重建的翻修手术与初次手术同样有效。
