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Abstract：
BACKGROUND Scaphoid nonunion (SN) is a challenging condition in wrist pathology, often resulting in severe consequences if left untreated. Surgical intervention, particularly using vascularized bone grafts (VBGs), is a promising but uncertain approach. The 4+5 extensor compartment artery (ECA) pedicled graft, less commonly used for SN, has potential benefits due to its vascular supply and accessibility to the scaphoid. This study aimed to evaluate the effectiveness of the 4+5 ECA pedicled graft combined with headless compression screw fixation in treating avascular necrosis (AVN)-induced proximal pole SN. Radiological results, functional outcomes, and complications related to this method were assessed. MATERIAL AND METHODS This was a retrospective analysis of 19 proximal pole SN cases with AVN treated using the 4+5 ECA-VBG technique from 2016 to 2022. Patients underwent preoperative evaluation and postoperative follow-up for at least 1 year. Data on surgery, demographics, radiological assessments, and functional outcomes were recorded and analyzed statistically. RESULTS All patients achieved radiographic union within 8.5 weeks postoperatively, with revascularization of proximal pole necrosis. Significant improvements in functional outcomes were observed, including pain reduction, increased wrist range of motion, improved grip and pinch strength, and enhanced wrist scores. No major complications were reported. CONCLUSIONS The 4+5 ECA-VBG technique, with headless compression screw fixation, showed high success rates in treating AVN-induced proximal pole SN. This method offers comprehensive restoration of wrist function and minimal complications, making it a viable option for SN management, especially in AVN cases. Further research is needed to confirm these results and establish standardized protocols for SN treatment.
摘要：
背景技术舟骨骨不连(SN)是腕部病理学中的一种具有挑战性的病症,如果不及时治疗，往往会导致严重后果。手术干预,特别是使用血管化骨移植物（VBG），是一种有希望但不确定的方法。4+5伸肌室动脉（ECA）带蒂移植，不太常用于SN，由于其血管供应和舟骨的可及性，具有潜在的好处。本研究旨在评估45ECA椎弓根移植物联合无头加压螺钉固定治疗无血管坏死（AVN）引起的近端SN的有效性。放射学结果,功能结果，并对与该方法相关的并发症进行了评估。材料与方法回顾性分析2016年至2022年采用4+5ECA-VBG技术治疗的近端SN伴AVN患者19例。患者接受术前评估和术后随访至少1年。手术数据,人口统计，放射学评估，并对功能结局进行记录和统计分析.结果所有患者在术后8.5周内均实现影像学愈合，近端极坏死的血运重建。观察到功能结果的显着改善，包括减轻疼痛,增加手腕的活动范围，改善的抓地力和捏强度，和增强的手腕得分。无重大并发症报告。结论4+5ECA-VBG技术，无头加压螺钉固定，在治疗AVN诱导的近端SN中显示出很高的成功率。这种方法提供了手腕功能的全面恢复和最小的并发症，使其成为SN管理的可行选择，尤其是在AVN病例中。需要进一步的研究来证实这些结果并建立SN治疗的标准化方案。
