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首页> 外文期刊>Hand >Failed Scaphoid Surgery With Nonunion, Bone Defect, and Loose Headless Screw Treated by Nonunion Resection, Bone Grafting, and Scaphoid Plating
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Failed Scaphoid Surgery With Nonunion, Bone Defect, and Loose Headless Screw Treated by Nonunion Resection, Bone Grafting, and Scaphoid Plating

机译：骨不连，骨缺损，植骨及舟骨入路治疗伴骨不连，骨缺损，无头螺钉松动的舟骨手术失败

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Objectives: Failed scaphoid osteosynthesis or failed scaphoid nonunion treatment with headless screw lead to a persistent scaphoid nonunion with loose screw, bone defect that is not just between proximal and distal fragment but also around loose screw within these fragments. Stable intramedullary screw fixation is seldom possible. In these cases, stable fixation maybe performed by using scaphoid plate and angular stable screws. Patient and Methods: Ten consecutive patients with persistent scaphoid nonunion after primary osteosynthesis for fracture treatment or after secondary treatment for scaphoid nonunion were within the group. Size of the fragments and bone defect within proximal and distal fragments did not allow operating surgeon to use headless screw for stabilization. All patients were treated by screw removal, nonunion resection, bone grafting by autograft from iliac crest, and stabilization by 1.5 mm scaphoid plate with angular stable screws through volar approach. Surgery was followed by 6 weeks of casting and 6 weeks of protected mobilization. All patients were followed clinically and radiologically at 2, 6, 12, and 24 weeks after surgery until clear signs of healing or nonhealing of the scaphoid. In case of doubts about the healing process, computed tomography (CT) scan was used for confirmation and patients were followed up to 18 months after surgery. In 2 patients with screw inserted from proximal pole, second approach was used with stabilization through volar approach. In 2 patients, removal of the screw was impossible so it was decided to leave the screw within the bone with grafting around it and applying adjacent plate stabilization on top. Results: Eight patients healed the scaphoid. Wrist synovitis disappeared with scaphoid stabilization. Pain subsided to 0 in 6 with return of full wrist motion and function. In 2 cases, residual motion limitation of 20° and 30° with residual pain at the end of motion arc in heavy load persisted. Two patients that failed to heal have persistent wrist synovitis, motion limitation, and pain with function restriction. One of the persistent nonunions was 9 years old nonunion and second had small proximal fragment with difficulty to fix proximal fragment with screws. In 4 patients, plate was removed in second setting. Discussion: Persistent scaphoid nonunion after previous attempts to heal it with loose headless screw within the bone mean structural problem for operating surgeon due to necessity to reconstruct shape of the bone and stabilize it by osteosynthesis. Intramedullary screws cannot be used in this occasion. Extramedullary stabilization by scaphoid plate and angular stable screws owes reliable stabilization necessary for scaphoid healing and maybe treatment of choice as we have shown in this presentation.
机译：目的：失败的舟骨骨合成术或无头螺钉的舟骨骨不连治疗失败导致持续的舟骨骨不连，伴有松动的螺钉，骨缺损不仅在近端和远端碎片之间，而且在这些碎片内的松散螺钉周围。几乎不可能进行稳定的髓内螺钉固定。在这些情况下，可以使用舟骨板和角度稳定的螺钉进行稳定的固定。患者与方法：连续10例在进行首次骨合成骨折治疗或进行二次治疗后因舟骨骨不连持续发生舟骨骨不连。碎片的大小以及近端和远端碎片中的骨缺损均不允许手术外科医生使用无头螺钉进行稳定。所有患者均接受了螺钉移除，不愈合切除、,骨自体植骨以及1.5 mm舟骨钢板固定，并采用掌侧入路用角度稳定的螺钉进行了固定。手术后进行6周的铸造和6周的保护动员。所有患者均在手术后第2、6、12和24周进行临床和放射学随访，直至舟骨舟状愈合或不愈合的明显迹象。如果对愈合过程有疑问，则使用计算机断层扫描（CT）扫描进行确认，并在术后18个月内对患者进行随访。在2例从近端极插入螺钉的患者中，采用第二种方法通过手掌入路进行稳定。在2例患者中，不可能去除螺钉，因此决定将螺钉留在骨头内，并在其周围进行移植，并在顶部进行相邻的钢板固定。结果：8例患者治愈了舟骨。手腕滑膜炎消失，舟骨稳定。腕部完全恢复运动并恢复功能后，疼痛减轻至6分之0。在2种情况下，在重载下持续存在20°和30°的残余运动限制以及运动结束时残余的疼痛。两名未能治愈的患者患有持续性腕滑膜炎，运动受限和功能受限的疼痛。一种持续性骨不连是9岁的骨不连，另一种是近端小碎片，难以用螺钉固定近端碎片。在4例患者中，第二个位置取下钢板。讨论：先前尝试用松散的无头螺钉在骨头内愈合的舟骨骨不连，这是手术外科医生的结构性问题，因为必须重建骨头的形状并通过骨合成使其稳定。在这种情况下，不能使用髓内螺钉。舟骨板和角度稳定的螺钉进行的髓外稳定，归因于舟骨愈合以及必要的治疗方法所必需的可靠稳定，正如我们在本演示中所展示的。

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