PDF(Pubmed)
Abstract：
OBJECTIVE: Scaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot-assisted fixation for the treatment of scaphoid nonunions.
METHODS: Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)-wires or a headless compression screw using a robotic navigation system.
RESULTS: Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K-wires. All the guidewires were placed with a single-attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow-up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient-rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients.
CONCLUSIONS: Arthroscopic bone grafting with robot-assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single-attempt using a robotic navigation system.
METHODS: Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)-wires or a headless compression screw using a robotic navigation system.
RESULTS: Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K-wires. All the guidewires were placed with a single-attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow-up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient-rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients.
CONCLUSIONS: Arthroscopic bone grafting with robot-assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single-attempt using a robotic navigation system.
摘要：
目的：肩关节骨不连仍然是一个具有挑战性的问题，其治疗建议尚未达成普遍共识。我们提出了一种新颖的微创（MIS）技术，可通过机器人辅助固定的关节镜植骨（ABG）来治疗舟骨骨不连。
方法：纳入了通过这种新型手术技术治疗的经影像学证实的舟骨骨不连的患者。关节镜下清创术和髂骨植骨术后，使用多根Kirschner（K）线或使用机器人导航系统的无头压紧螺钉经皮固定舟骨。
结果：纳入6名男性患者，平均年龄29.2岁。四名患者患有舟骨腰部骨折，另外两个是近端极骨折。在腕关节镜检查期间，在6例患者中，有4例观察到近端舟骨碎片的点状出血。一半的患者使用无头压紧螺钉固定，另一半使用多根K线固定。使用机器人导航系统一次性放置所有导丝。术后,到16周时,所有舟骨骨折均有影像学完全愈合.平均随访18.3个月,手腕的活动范围有了显著的改善，握力,和患者评估的结果。我们的任何患者均未遇到术中或术后早期并发症。
结论：机器人辅助固定的关节镜植骨是治疗舟骨骨不连的一种可行且有前景的选择，无论近端极碎片的血管分布如何。这种新颖的技术允许解剖恢复的舟骨对齐和准确，使用机器人导航系统在一次尝试中将植入物有针对性地放置到舟骨骨不连部位。
方法：纳入了通过这种新型手术技术治疗的经影像学证实的舟骨骨不连的患者。关节镜下清创术和髂骨植骨术后，使用多根Kirschner（K）线或使用机器人导航系统的无头压紧螺钉经皮固定舟骨。
结果：纳入6名男性患者，平均年龄29.2岁。四名患者患有舟骨腰部骨折，另外两个是近端极骨折。在腕关节镜检查期间，在6例患者中，有4例观察到近端舟骨碎片的点状出血。一半的患者使用无头压紧螺钉固定，另一半使用多根K线固定。使用机器人导航系统一次性放置所有导丝。术后,到16周时,所有舟骨骨折均有影像学完全愈合.平均随访18.3个月,手腕的活动范围有了显著的改善，握力,和患者评估的结果。我们的任何患者均未遇到术中或术后早期并发症。
结论：机器人辅助固定的关节镜植骨是治疗舟骨骨不连的一种可行且有前景的选择，无论近端极碎片的血管分布如何。这种新颖的技术允许解剖恢复的舟骨对齐和准确，使用机器人导航系统在一次尝试中将植入物有针对性地放置到舟骨骨不连部位。
