Wataya Erick Yoshio, Sousa Antonio Isidoro, Tomé Thales Augusto, Nakamoto Joao Carlos, de Rezende Marcelo Rosa, Mattar Rames
Universidade de Sao Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia (IOT HCFMUSP), Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil.
Acta Ortop Bras. 2025 Sep 8;33(4):e290649. doi: 10.1590/1413-785220253304e290649. eCollection 2025.
To make a comparative analysis of patients with scaphoid pseudarthrosis operated with screw and corticocancellous graft and patients operated with plate and cancellous graft only, in regards to consolidation, carpal stability and limb functionality.
non-randomized retrospective cohort study. Nineteen patients with scaphoid pseudarthrosis without advanced collapse were included in the study, of which 9 patients operated with screw and corticocancellous graft (Group A) and 10 operated with plate using cancellous graft (Group B). The following were evaluated preoperatively and 12 weeks postoperatively: functional recovery using the visual analogue scale, range of motion, grip strength, digital pinch strength, DASH and MAYO wrist score functional scales. To assess carpal instability, the scapholunate and radiolunate angles were assessed on radiographs and the interscaphoid angle on CT. And the bone consolidation rate was assessed with CT in the 8th postoperative week.
group A with 90% and B with 100% consolidation rate, however the latter with a longer average time for consolidation - 9.7 weeks (p = 0.002). Improvement in pain intensity was achieved in both groups (p = 0.03). Increased pinch strength (p=0.04) and grip strength in group B and decreased in group A. The range of motion was superior in group B, with loss of ulnar deviation (p=0.02) and radial deviation (p=0.007) in group A. Regarding the MAYO wrist score, there was loss of function in group A and an increase in group B (p=0.007). There was correction of the scapholunate angle in both groups (p=0.03), with no difference between them.
Patients in group B had better recovery of range of motion, pinch and grip strength, and better functionality according to the MAYO wrist score.
对采用螺钉和皮质松质骨移植手术治疗的舟状骨假关节患者与仅采用钢板和松质骨移植手术治疗的患者在骨愈合、腕关节稳定性和肢体功能方面进行对比分析。
非随机回顾性队列研究。本研究纳入19例无晚期塌陷的舟状骨假关节患者，其中9例采用螺钉和皮质松质骨移植手术（A组），10例采用钢板加松质骨移植手术（B组）。在术前及术后12周对以下指标进行评估：使用视觉模拟量表评估功能恢复情况、活动范围、握力、手指捏力、DASH和MAYO腕关节评分功能量表。为评估腕关节不稳，通过X线片评估舟月角和桡月角，通过CT评估舟骨间角。并在术后第8周通过CT评估骨愈合率。
A组骨愈合率为90%，B组为100%，但后者平均愈合时间更长，为9.7周（p = 0.002）。两组疼痛强度均有改善（p = 0.03）。B组捏力（p = 0.04）和握力增加，A组握力下降。B组活动范围更佳，A组尺偏（p = 0.02）和桡偏（p = 0.007）丧失。关于MAYO腕关节评分，A组功能丧失，B组功能增加（p = 0.007）。两组舟月角均得到矫正（p = 0.03），两组间无差异。
根据MAYO腕关节评分，B组患者在活动范围、捏力和握力恢复以及功能方面表现更佳。
