手术技术：“穿孔补骨”技术植骨固定舟状骨骨折

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.12.007

Mehek Gupta MBBS , Heng Qi Hui Bernice MBBS, MRCS , Mala Satkunanantham MRCS, MMed , Tina Munn Yi Lee MRCS, FAMS , Xu Jieying MRCS, FRCS , Lam-Chuan Teoh MMed, FRCS

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引用次数: 0

摘要

目的介绍“穿孔补骨”技术用于舟状骨延迟愈合不愈合骨折的植骨，该技术既保留了软骨壳，又不破坏纤维性骨不愈合。本文介绍了11例舟状骨骨折的技术和经验。方法回顾性分析我院2017年7月至2024年6月11例舟状骨骨折采用骨栅技术手术治疗的临床资料。考虑了患者和骨折因素、骨缺损的x线测量、术后片以及主观和客观结果。结果骨折x线愈合36 ~ 110天，平均68天。在最后一次随访中，所有病例中受影响的手腕均无疼痛，并且能够恢复其发病前的职业状态并恢复所有体育活动。在9例患者中，他们的手腕总运动（包括屈曲、伸展、桡侧和尺侧偏移）测量为130°至195°（平均172°，93%的对侧手腕）。在这9个案例中，他们的握力测量为28-50公斤（平均31.5公斤，是另一只手的97%）。结论“穿孔补骨”技术是治疗舟骨骨折延迟愈合和骨不愈合的较好方法。在我们的11例使用该技术的病例中，保持软骨壳完整内聚愈合和微创入路的优势可能有助于骨折愈合的成功。研究类型/证据水平治疗性IV。

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Surgical Technique: “Perforate and Fill” Technique of Bone Grafting for Scaphoid Fracture Fixation

Purpose

We introduce the “Perforate and Fill” technique for bone grafting of scaphoid fracture with delayed union and nonunion, which preserves the cartilage shell and does not break open the fibrous nonunion. This article describes the technique and reports the experience in 11 scaphoid fractures.

Methods

The records of 11 patients whose scaphoid fractures were managed surgically with this bone grating technique from our institution from July 2017 to June 2024 were reviewed retrospectively. Patient and fracture factors, radiographic measurements of bone defect, postoperative films, and subjective and objective outcomes were considered.

Results

The radiographic union of the fracture ranges from 36 to 110 days (an average of 68 days). In the last follow-up review, the affected wrists were pain free in all cases, and they were able to resume their premorbid status of vocation and resumed all physical activities. In nine cases, their total wrist motion (including flexion, extension, radial, and ulnar deviation) measured 130° to 195° (an average of 172° and 93% of the opposite wrists). In these nine cases, their grip strengths measured 28–50 kg (an average of 31.5 kg and is 97% of the opposite hand).

Conclusions

In conclusion, in treatment of scaphoid fracture delayed union and nonunion, the “Perforate and Fill” technique of bone grafting is a good alternative to the conventional wedge grafting technique. The advantage of keeping the intact cohesive union of cartilage shell and a less-invasive approach may contribute to the success of the fracture union in our 11 cases using this technique.