Abstract：
BACKGROUND: Bone grafts for scaphoid nonunion with deformity include cortcicocancellous or pure cancellous bone grafts. This study compared the outcomes between two types of bone grafts when employing a volar locking-plate in patients with scaphoid nonunion with dorsal intercalated segmental instability (DISI).
METHODS: This retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes.
RESULTS: Nineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion-extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences.
CONCLUSIONS: Volar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports.
METHODS: This retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes.
RESULTS: Nineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion-extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences.
CONCLUSIONS: Volar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports.
摘要：
背景：治疗有畸形的舟骨骨不连的骨移植包括皮质骨细胞或纯松质骨移植。这项研究比较了两种类型的骨移植物在使用掌侧锁定钢板治疗舟骨骨不连伴背侧夹层节段不稳定（DISI）患者时的结果。
方法：这项回顾性研究包括2017年3月至2022年1月期间治疗的34例由于驼背畸形导致的舟骨骨不连和DISI患者。从髂骨获得两种类型的骨移植物。皮质松质（CC）组中有20个接受了楔形移植物，而纯松质（C-only）组的14例患者接受了移植片。在这两组中,使用1.5毫米的解剖学预轮廓锁定板进行固定。射线照相评估包括结合率和腕骨对齐，包括肩胛骨角（SLA），放射状角(RLA),舟内角度（ISA）和舟骨高度与长度之比（HLR）。临床评估包括手腕活动范围，握力,和患者报告的结果。
结果：CC组20例患者中的19例，仅C组14例患者中的12例，实现骨结合。CC组的平均随访期为14.7（范围，12-24个月)，仅C组为12.6个月(范围，12-15）个月。术后,包括SLA在内的放射学参数没有显着组间差异（CC；49.9°±6.7°vs.仅C;48.9°±3.5°,P=0.676),RLA(1.7°±6.4°vs.2.4°±3.3°,P=0.74),ISA(36°±7.5°vs.36.6°±12.2°,P=0.881),和HLR(0.54±0.09vs.0.53±0.05,P=0.587)。临床结果,包括屈伸弧(137°±30°与158°±33°,P=0.122),握力(93.4%±15.4%vs.99.5%±16.7%,P=0.39),手臂的快速残疾，肩膀,和手得分（11.2±8.3vs.12.5±7.7，P=0.74）和梅奥手腕得分（81.2±13.1vs.89±11.4，P=0.242）也没有显着组间差异。
结论：在伴有畸形的舟骨骨不连中，采用单纯松质骨移植的掌侧锁定钢板固定所取得的结果与采用皮质松质骨移植所取得的结果相当。可能是由于掌侧板提供结构支撑的生物力学优势。
方法：这项回顾性研究包括2017年3月至2022年1月期间治疗的34例由于驼背畸形导致的舟骨骨不连和DISI患者。从髂骨获得两种类型的骨移植物。皮质松质（CC）组中有20个接受了楔形移植物，而纯松质（C-only）组的14例患者接受了移植片。在这两组中,使用1.5毫米的解剖学预轮廓锁定板进行固定。射线照相评估包括结合率和腕骨对齐，包括肩胛骨角（SLA），放射状角(RLA),舟内角度（ISA）和舟骨高度与长度之比（HLR）。临床评估包括手腕活动范围，握力,和患者报告的结果。
结果：CC组20例患者中的19例，仅C组14例患者中的12例，实现骨结合。CC组的平均随访期为14.7（范围，12-24个月)，仅C组为12.6个月(范围，12-15）个月。术后,包括SLA在内的放射学参数没有显着组间差异（CC；49.9°±6.7°vs.仅C;48.9°±3.5°,P=0.676),RLA(1.7°±6.4°vs.2.4°±3.3°,P=0.74),ISA(36°±7.5°vs.36.6°±12.2°,P=0.881),和HLR(0.54±0.09vs.0.53±0.05,P=0.587)。临床结果,包括屈伸弧(137°±30°与158°±33°,P=0.122),握力(93.4%±15.4%vs.99.5%±16.7%,P=0.39),手臂的快速残疾，肩膀,和手得分（11.2±8.3vs.12.5±7.7，P=0.74）和梅奥手腕得分（81.2±13.1vs.89±11.4，P=0.242）也没有显着组间差异。
结论：在伴有畸形的舟骨骨不连中，采用单纯松质骨移植的掌侧锁定钢板固定所取得的结果与采用皮质松质骨移植所取得的结果相当。可能是由于掌侧板提供结构支撑的生物力学优势。
