腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合

Treatment of pseudoarticular scaphoid nonunion with bone graft and percutaneous fixation under wrist arthroscopy

目的探讨腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合的疗效。方法回顾性分析2015年10月至2018年10月徐州仁慈医院手外科治疗的6例假关节型舟骨骨折不愈合患者资料。男5例,女1例;年龄28~51岁,平均39.5岁;左侧4例,右侧2例。采用腕关节镜下磨除硬化骨,从腕中关节入路置入套筒,经套筒植入自体松质骨屑并压实,然后进行经皮内固定。对于假关节间隙完全分离导致桡腕关节与腕中关节相通者,从3/4入路置入球囊导尿管阻挡假关节间隙的基底部,防止松质骨屑从假关节间隙向下漏入桡腕关节。末次随访时采用改良Mayo腕关节评分标准(MEPS)评估腕关节功能,并记录腕关节屈伸总活动度和腕关节尺桡偏总活动度。结果6例患者手术时间2~4 h,平均3.2 h;术后随访时间6~15个月(平均11.3个月)。所有患者均获骨性愈合,愈合时间8~14周,平均12.1周。腕关节屈伸总活动度为75°~135°,平均107.0°,为健侧的85%;腕关节尺桡偏总活动度为40°~80°,平均51.5°,为健侧的88%。末次随访时采用改良MEPS评分进行评估:优4例,良1例,中1例。结论腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合,是一种可靠、有效的微创治疗。

Objective To evaluate the treatment of pseudoarticular scaphoid nonunion with bone graft and percutaneous fixation under wrist arthroscopy.Methods Six patients with pseudoarticular scaphoid nonunion were treated with arthroscopic debridement,bong grafting and percutaneous fixation between October 2015 and October 2018 at Department of Hand Surgery,Xuzhou Renci Hospital.They were 5 men and one woman with 4 left and 2 right sides affected,aged from 28 to 51 years(mean,39.5 years).The sclerotic bone was erased under wrist arthroscopy.Percutaneous fixation started after autoallergic cancellous bone chips were implanted and impacted through a sleeve inserted via the medial carpal approach.For the nonunion with a pseudarthrosis connecting the midcarpal and radiocarpal joints,we put an inflated Foley catheter through a 3/4 portal underneath the proximal edge of the pseudarthrosis to block the possible leakage of the small cancellous bone chips.The wrist functions were evaluated at the final follow-up using the modified Mayo elbow performance score(MEPS);the flexion-extension motion and ulnar-radial deviation of the wrist were recorded.Results The operation time for the 6 patients ranged from 2 to 4 hours(average,3.2 hours);their follow-up duration ranged from 6 to 15 months(average,11.3 months).All the patients obtained bony union after 8 to 14 weeks(average,12.1 weeks).The flexion-extension motion of their affected wrist ranged from 75°to 135°(average,107.0°),accounting for 85%of that of the healthy side;the ulnar-radial deviation of their affected wrist ranged from 40°to 80°(average,51.5°),accounting for 88%of that of the healthy side.MEPS at the final follow-up revealed 4 excellent,one good and one fair cases.Conclusion Arthroscopic bone grafting and percutaneous fixation is a reliable and effective minimally invasive treatment for pseudarthrotic scaphoid nonunions.