针对慢性和非慢性肩胛骨骨折不愈合的肩胛骨远端切除术

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-07-01 DOI:10.1016/j.jhsg.2024.03.013

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引用次数: 0

摘要

目的肩胛骨远端切除术的适应症仅限于肩胛骨周围的局部腕关节炎、肩胛骨未愈合晚期塌陷或肩胛-腕-肘关节关节炎。从历史上看，该手术能缓解症状并改善力量。我们的目的是研究该手术在肩胛骨骨折不愈合患者中的疗效。方法这是一项单中心回顾性病例系列研究，对连续 12 例肩胛骨骨折不愈合后接受肩胛骨远端切除术的患者进行了研究。根据骨折不愈合的慢性程度将患者分为以下两组：慢性组（一年以上）和非慢性组（一年以下）。我们的队列由 12 名患者组成，其中 10 名男性（83%），2 名女性（17%），平均年龄为 37.6 ± 13.6 岁。8名患者为慢性肩胛骨骨折不愈合（6名患者为被忽视的肩胛骨骨折，2名患者为肩胛骨切开复位植骨内固定术后不愈合），4名患者为非慢性骨折不愈合（2名患者石膏治疗失败，2名患者为肩胛骨切开复位植骨内固定术后不愈合）。手术前，所有患者都主诉疼痛，四名患者有麻木感（均为慢性组）。术后平均 21 周后，七名患者（58%）报告仍有疼痛，两名患者报告尺侧疼痛，一名患者接受了关节镜滑膜切除术。所有开始时桡钝角正常的患者术后桡钝角仍然正常，而术前有背侧闰节段不稳定的患者术后仍然不稳定，只有一名患者接受了掌骨中段融合术，其桡钝角得到了矫正。对于近期治疗失败的肩胛骨骨折患者，也可采用远端肩胛骨切除术进行治疗。

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Distal Scaphoid Excision for Chronic and Nonchronic Scaphoid Fracture Nonunion

Purpose

The indications for distal scaphoid excision are limited to localized wrist arthritis surrounding the scaphoid, as a result of scaphoid nonunion advanced collapse or scapho-trapezio-trapezoid joint arthritis. The procedure historically has led to relief of symptoms and improvement in strength. Our aim was to examine the outcomes of this procedure in patients with scaphoid fracture nonunion.

Methods

This is a single-center retrospective case series of 12 consecutive patients who underwent distal scaphoid excision after scaphoid fracture nonunion. Patients were divided into the following two groups based on nonunion chronicity: chronic (more than a year) and nonchronic (less than a year). Clinical and radiographic data were examined using descriptive statistics.

Results

Our cohort consisted of 12 patients, 10 men (83%) and 2 women (17%), with a mean age of 37.6 ± 13.6 years. Eight patients had a chronic scaphoid fracture nonunion (six had a neglected scaphoid fracture and two had a nonunion after scaphoid open reduction and internal fixation with bone graft), and four patients had a nonchronic fracture nonunion (two had failed cast treatment and two had nonunion after scaphoid open reduction and internal fixation with bone graft). Before surgery, all patients complained of pain and four had numbness (all in the chronic group). After an average of 21 weeks after surgery, seven patients (58%) reported continued pain, two patients reported ulnar side pain, and one underwent arthroscopic synovectomy. All patients who started with a normal radiolunate angle continued to have a normal angle, whereas patients who had dorsal intercalated segmental instability prior to surgery persisted with it after surgery, except for a patient who underwent midcarpal fusion and had their radiolunate angle corrected.

Conclusions

Distal scaphoid excision is an effective procedure for carefully selected patients with periscaphoid wrist arthrosis. Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection.