Karimnazhand Reza, Shams Roshanak, Behmanesh Ali, Vosough Masoud, Gharooee Ahangar Azadeh, Barrenechea Laura Serrano, Mahmoudinasab Omid, Najd Mazhar Farid
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
J Orthop Translat. 2025 Jun 28;53:231-245. doi: 10.1016/j.jot.2025.06.009. eCollection 2025 Jul.
Scaphoid fractures are prevalent wrist injuries with significant treatment challenges, especially when get complicated by nonunion and avascular necrosis. Various grafting techniques, including non-vascularized bone grafts (NVBGs), vascularized bone grafts (VBGs), and bone biomaterial grafts, are utilized to promote healing, but the comparative efficacy of these methods remains unclear.
This systematic review and meta-analysis aim to assess the efficacy of different types of bone grafts (NVBGs, VBGs, and bone biomaterials) in the treatment of scaphoid nonunion, focusing on outcomes including union rates, time to healing, and functional recovery scores.
A systematic search of PubMed, Scopus, Cochrane and Web of Science was conducted to identify eligible studies published between 2000 and 2024. studies were categorized into: (1) comparative studies of NVBG vs. VBG, (2) studies reporting only NVBG outcomes, and (3) studies reporting only VBG outcomes. Bone Biomaterials were assessed separately due to limited data (one study). Meta-analyses were performed on in common reported outcomes for each group including union rates, time to healing, range of motion, grip strength, and Modified Mayo Wrist Scores (MMWS).
A total of 62 studies involving 2332 scaphoid nonunion patients were included. VBGs demonstrated significantly higher union rates and shorter healing times compared to NVBGs. VBG-treated patients also showed better functional outcomes, including greater grip strength and MMWS in comparative studies NVBGs were less effective in evaluated cases and required longer healing times. The use of bone biomaterial grafts, although limited in the current literature, showed promising results comparable to NVBGs, but further studies are needed.
VBGs demonstrated higher union rates and shorter healing times compared to NVBGs, with better functional outcomes in some cases, though evidence certainty is moderate. Bone biomaterials represent a promising alternative to traditional grafts but require more evidence to support their widespread use. Treatment decision-makers should consider clinical context and case-specific conditions. Further research is needed to confirm these trends.Translational potential: This study helps clinical decision-making by evaluating the efficacies of different bone grafts outcomes in complex scaphoid nonunions, potentially reducing treatment failures. It also underscores the emerging role of bone biomaterial grafts as a less invasive alternative, paving the way for personalized orthopedic strategies needing further evaluations to be used for treating scaphoid nonunions.
舟骨骨折是常见的腕部损伤，治疗面临重大挑战，尤其是出现骨不连和缺血性坏死等并发症时。包括非血管化骨移植（NVBG）、血管化骨移植（VBG）和骨生物材料移植在内的各种移植技术被用于促进愈合，但这些方法的相对疗效仍不明确。
本系统评价和荟萃分析旨在评估不同类型骨移植（NVBG、VBG和骨生物材料）治疗舟骨骨不连的疗效，重点关注愈合率、愈合时间和功能恢复评分等结果。
对PubMed、Scopus、Cochrane和Web of Science进行系统检索，以确定2000年至2024年发表的符合条件的研究。研究分为：（1）NVBG与VBG的比较研究，（2）仅报告NVBG结果的研究，（3）仅报告VBG结果的研究。由于数据有限（一项研究），对骨生物材料进行单独评估。对每组常见报告结果进行荟萃分析，包括愈合率、愈合时间、活动范围、握力和改良梅奥腕关节评分（MMWS）。
共纳入62项研究，涉及2332例舟骨骨不连患者。与NVBG相比，VBG显示出显著更高的愈合率和更短的愈合时间。在比较研究中，接受VBG治疗的患者在功能结果方面也表现更好，包括更大的握力和MMWS。NVBG在评估病例中的效果较差，愈合时间更长。骨生物材料移植的应用在当前文献中虽有限，但显示出与NVBG相当的有前景的结果，但仍需进一步研究。
与NVBG相比，VBG显示出更高的愈合率和更短的愈合时间，在某些情况下功能结果更好，尽管证据确定性为中等。骨生物材料是传统移植的一种有前景的替代方法，但需要更多证据支持其广泛应用。治疗决策者应考虑临床背景和具体病例情况。需要进一步研究来证实这些趋势。转化潜力：本研究通过评估不同骨移植在复杂舟骨骨不连中的疗效来帮助临床决策，可能减少治疗失败。它还强调了骨生物材料移植作为一种侵入性较小的替代方法的新兴作用，为需要进一步评估用于治疗舟骨骨不连的个性化骨科策略铺平了道路。
