Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonu...Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.展开更多
The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonuni...The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.展开更多
BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is kn...BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.展开更多
Objective To introduce the utilization of absorbable screw internal fixation to cure the nonunion of old scaphoid fracture.Methods From January 1998 to July 2003,13 cases of old scaphoid fracture were treated with ope...Objective To introduce the utilization of absorbable screw internal fixation to cure the nonunion of old scaphoid fracture.Methods From January 1998 to July 2003,13 cases of old scaphoid fracture were treated with open reduction and internal fixation with a small incision at the wrist radial-dorsal side.Results After operation,all cases were recovered.Only 2 cases occurred with restriction of wrist joint motion,and there was no obvious improvement compared with preoperative situation.These two patients felt pain occasionally in their daily life.Conclusion Absorbable screw has a better biocompatibility and its intensity is enough to keep the stability of cancellous bone to union.It also can be absorbed thoroughly so as to make for the bone repair.So absorbable screw is a kind of ideal material for the use of internal fixation.展开更多
目的探讨1、2伸肌间室支持带上动脉(the first and second intercompartmental supraretinacular artery,1,2 ICSRA)桡骨瓣治疗舟骨骨不连的可行性及疗效。方法收集47例正常人腕关节CT数据,分别测量桡骨茎突尖端到舟骨长轴近极及远极距...目的探讨1、2伸肌间室支持带上动脉(the first and second intercompartmental supraretinacular artery,1,2 ICSRA)桡骨瓣治疗舟骨骨不连的可行性及疗效。方法收集47例正常人腕关节CT数据,分别测量桡骨茎突尖端到舟骨长轴近极及远极距离,并与1,2 ICRSA血管蒂的长度进行对比,分析1,2 ICSRA桡骨瓣治疗舟骨骨不连的可行性。对23例舟骨骨不连患者实施1,2 ICSRA桡骨瓣结合Herbert钉内固定手术治疗,随访患者骨折愈合情况;采用Cooney腕关节评分评估患者局部症状和功能。结果桡骨茎突尖端到舟骨长轴近极和远极距离分别为(15.66±1.89)mm和(17.07±1.60)mm,均小于1,2 ICSRA血管蒂长度。23例患者术后舟骨均获得愈合;随访时间(51.08±11.30)月,末次随访时21例患者腕关节疼痛感消失,2例患者重体力劳动时有轻微疼痛,但症状较术前得到明显改善;Cooney腕关节评分优20例,良3例,从术前(62.39±7.21)分提高至术后(92.39±4.23)分,差异有统计学意义(t=17.213,P=0)。结论1,2 ICSRA桡骨瓣长度足以覆盖舟骨任何部位,该方法治疗舟骨骨不连具备可行性且疗效肯定。展开更多
文摘Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.
文摘The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.
文摘BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
文摘Objective To introduce the utilization of absorbable screw internal fixation to cure the nonunion of old scaphoid fracture.Methods From January 1998 to July 2003,13 cases of old scaphoid fracture were treated with open reduction and internal fixation with a small incision at the wrist radial-dorsal side.Results After operation,all cases were recovered.Only 2 cases occurred with restriction of wrist joint motion,and there was no obvious improvement compared with preoperative situation.These two patients felt pain occasionally in their daily life.Conclusion Absorbable screw has a better biocompatibility and its intensity is enough to keep the stability of cancellous bone to union.It also can be absorbed thoroughly so as to make for the bone repair.So absorbable screw is a kind of ideal material for the use of internal fixation.
文摘目的探讨1、2伸肌间室支持带上动脉(the first and second intercompartmental supraretinacular artery,1,2 ICSRA)桡骨瓣治疗舟骨骨不连的可行性及疗效。方法收集47例正常人腕关节CT数据,分别测量桡骨茎突尖端到舟骨长轴近极及远极距离,并与1,2 ICRSA血管蒂的长度进行对比,分析1,2 ICSRA桡骨瓣治疗舟骨骨不连的可行性。对23例舟骨骨不连患者实施1,2 ICSRA桡骨瓣结合Herbert钉内固定手术治疗,随访患者骨折愈合情况;采用Cooney腕关节评分评估患者局部症状和功能。结果桡骨茎突尖端到舟骨长轴近极和远极距离分别为(15.66±1.89)mm和(17.07±1.60)mm,均小于1,2 ICSRA血管蒂长度。23例患者术后舟骨均获得愈合;随访时间(51.08±11.30)月,末次随访时21例患者腕关节疼痛感消失,2例患者重体力劳动时有轻微疼痛,但症状较术前得到明显改善;Cooney腕关节评分优20例,良3例,从术前(62.39±7.21)分提高至术后(92.39±4.23)分,差异有统计学意义(t=17.213,P=0)。结论1,2 ICSRA桡骨瓣长度足以覆盖舟骨任何部位,该方法治疗舟骨骨不连具备可行性且疗效肯定。
