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Abstract：
Background Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results. Case Description The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP. Literature Review A literature review of all available journal articles citing the use of BMP in scaphoid nonunion surgery from 2002 to 2019 was conducted. We included studies that used BMP as an adjunct to surgical treatment for scaphoid nonunions in both the primary and revision settings with computed tomography determination of union. Demographic information, dose of BMP, tobacco use, outcomes, and complications were recorded. A total of 21 cases were included from four different studies meeting inclusion criteria. Clinical Relevance The union rates were 90.5% overall, 100% for primary surgeries, and 77.8% for revision surgeries. Five patients (24%) experienced 11 complications, including four cases (19%) of heterotrophic ossification. Use of BMP in scaphoid nonunion surgery resulted in a 90.5% overall union rate but was also associated with complications such as heterotopic ossification. All included studies used BMP to augment bone graft, screw or wire fixation, or a combination of methods. The efficacy of BMP in scaphoid nonunion is unclear, and a sufficiently powered, randomized controlled trial is needed to determine optimal fixation methods, dosing, and morbidity of the use of BMP. Level of Evidence This is a Level IC, therapeutic interventional study.
摘要：
背景：舟骨骨不连可导致腕骨塌陷和骨关节炎，令人痛苦的衰弱问题。骨形态发生蛋白（BMP）已成功实施，以增强骨愈合在其他情况下，但是它在舟骨骨不连中的使用产生了相互矛盾的结果。病例描述本研究的目的是评估BMP手术治疗舟骨骨不连的结果和并发症。文献综述对2002年至2019年所有可用的期刊文章进行了文献综述，其中引用了BMP在舟骨骨不连手术中的使用。我们纳入了在主要和翻修设置中使用BMP作为手术治疗舟骨骨不连的辅助方法的研究，并通过计算机断层扫描确定结合。人口统计信息,剂量的BMP，烟草使用,结果，并记录并发症。共纳入来自符合纳入标准的4项不同研究的21例病例。临床相关性总体结合率为90.5%，100%用于初级手术，翻修手术占77.8%。5例患者（24%）出现11种并发症，包括4例（19%）异养骨化。在舟骨骨不连手术中使用BMP可导致90.5％的整体愈合率，但也与异位骨化等并发症有关。所有纳入的研究都使用BMP来增强骨移植物，螺钉或金属丝固定，或多种方法的组合。BMP在舟骨骨不连中的疗效尚不清楚，和一个足够的动力，需要随机对照试验来确定最佳的固定方法，给药,和使用BMP的发病率。证据级别这是IC级别,治疗性介入研究。
