目的:舟骨不愈合导致骨关节炎,但相关因素了解甚少。我们调查了舟骨骨折不愈合后骨关节炎的发生率,持续时间和骨折位置是否影响关节炎及其严重程度。
方法:这项回顾性的横断面观察性研究涉及278例连续的舟骨骨折不愈合病例,不联合持续时间,骨折位置,背侧插层节段不稳定(DISI),腕关节关节炎的严重程度和分布。患者评估措施(PEM)和生活质量评估对患者的影响。回归模型研究了不同变量对骨关节炎的预测。时间至事件分析调查骨关节炎的演变。估算并分析了PEM和QoL的缺失(MAR)数据。
结果:278名患者,246名男性,27.9岁(范围11至78岁),检查了计算机断层扫描(CT)扫描(243)和X线平片(35)证实的舟骨骨折不愈合。损伤和成像之间的间隔为3.3年(SD5.9年;范围0.1-45)。骨折在162中近脊,在83中远脊,在33中近脊20%。DISI(RLA≥10°)发生率为93.5%(260/278)。在62.2%(173/278)中发现了骨关节炎,我们将SNAC模式分类为93.6%(162/173)。其中,100(61.7%)具有SNAC1、22(13.6%)SNAC2、17(10.5%)SNAC3和23(14.2%)SNAC4。SNAC1、2、3和4的平均持续时间分别为2.5、6.0、8.2和11.3年。在山脊附近的骨折中,50%在2.2年内有关节炎。而在近端极点,远离山脊,50%在3.8年和6.6年发展,分别。无关节炎患者的PEM评分为42.8%(SD18.9%),关节炎患者的PEM评分为48.8%(SD21.5%)。无SNAC患者的平均QoL为0.838,有SNAC患者的平均QoL为0.792。
结论:舟骨骨折不愈合导致早期腕骨塌陷,大多数患者通常在损伤后一年内观察到骨关节炎,最早发生在腰部近端骨折.骨关节炎的分布(SNAC阶段)可能并不总是遵循一个独特的模式,如前所述。
OBJECTIVE: Scaphoid non-union causes osteoarthritis but factors associated are poorly understood. We investigated the rate of osteoarthritis after scaphoid fracture non-union, and if duration and fracture location influenced arthritis and its severity.
METHODS: This retrospective cross-sectional observational study of 278 consecutive cases with scaphoid fracture non-union retrieved data on demographics, non-union duration, fracture location, dorsal intercalated segment instability (
DISI), severity and distribution of wrist arthritis. Patient Evaluation Measure (PEM) and Quality of Life assessed impact on patients. Regression models investigated prediction of osteoarthritis by different variables. Time-to-event analysis investigated osteoarthritis evolution. Missing (MAR) data for the PEM and QoL was imputed and analysed.
RESULTS: 278 patients, 246 males, aged 27.9 years (range 11 to 78 years), with a scaphoid fracture non-union confirmed on computed tomography (CT) scans (243) and plain radiographs (35) were reviewed. The interval between injury and imaging was 3.3 years (SD 5.9 years; range 0.1-45). The fracture was proximal to the ridge in 162, distal to the ridge in 83 and in the proximal 20% in 33.
DISI (RLA ≥ 10°) occurred in 93.5% (260/278). Osteoarthritis was identified in 62.2% (173/278), and we classified a SNAC pattern in 93.6% (162/173). Of these, 100 (61.7%) had SNAC 1, 22 (13.6%) SNAC 2, 17 (10.5%) SNAC 3, and 23 (14.2%) SNAC 4. The mean duration in years for SNAC 1, 2, 3 and 4 were 2.5, 6.0, 8.2, and 11.3 years respectively. In fractures proximal to the ridge, 50% had arthritis in 2.2 years. Whereas in proximal pole, and distal to the ridge, 50% developed in 3.8 and 6.6 years, respectively. The PEM score was 42.8% (SD 18.9%) in those without arthritis and 48.8% (SD 21.5%) in those with arthritis. The mean QoL was 0.838 in patients without SNAC and 0.792 with SNAC.
CONCLUSIONS: Scaphoid fracture non-union caused early carpal collapse, majority had osteoarthritis usually observed within a year following injury and occurred earliest in proximal waist fractures. Distribution of osteoarthritis (SNAC stage) may not always follow a distinctive pattern, as previously described.