Application of wrist arthroscopy in treating scaphoid nonunion advanced collapse / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical effect of wrist arthroscopy in the treatment of scaphoid nonunion advanced collapse (SNAC).Methods A retrospective case series study was performed on the clinical data of 15 SNAC patients admitted from March 2011 to January 2016.There were 12 males and three females,with a mean age of 32 years (range,26-43 years).There were nine cases of right wrist injury and six cases of left wrist injury.The injury duration was 14-72 months,with an average of 18 months.According to the evaluation of the extent of wrist joint inflammation involvement under wrist arthroscopy,there were nine cases at SNAC Ⅰ stage,four at stage Ⅱ,and two at stage Ⅲ.Stage Ⅰ patients underwent wrist arthroscopy assisted radius styloid process resection,scaphoid sclerosis bone removal,and iliac bone grafting and internal fixation.Stage Ⅱ and Ⅲ patients underwent wrist arthroscopy assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone.Joint healing time in the first month of fracture and fusion,visual analogue score (VAS) before operation and at the last follow up,joint mobility,and grip strength were recorded.Wrist function was evaluated by modified Mayo wrist function score at the last follow up.Results The patients were followed up for 9-23 months,with an average of 14 months.All cases were seen primary bone healing.The mean time of fracture healing was 11.7 weeks in stage Ⅰ SNAC patients and the mean healing time was 11 weeks in stage Ⅱ and Ⅲ patients in the first month of joint fusion.VAS decreased from (5.9 ± 0.8) points to (1.6 ± 0.9) points.Range of motion of the wrist including the flexion/extension arc and the radial/ulnar deviation arc increased respectively from preoperative (38.7 ± 6.3) °,(28.6 ± 11.2) °,(19.8 ± 1.4) °and (22.7±5.7) ° to postoperative (54.1 ±5.8)°,(43.3±9.3)°,(22.0±1.9) ° and (30.3± 4.3) °.Grip strength was improved from preoperative (10.7 ± 2.4) kg to postoperative (15.0 ± 1.9) kg (all P ＜ 0.05).The modified Mayo wrist score was increased from preoperative (57.9 ± 7.3) points to postoperative (84.5 ± 6.9) points (P ＜ 0.05).According to modified Mayo wrist scores,the result was excellent in one case,good in nine cases and fair in five.Conclusions For patients with SNAC,it is necessary to evaluate the staging under wrist arthroscopy.Arthroscopy assisted scaphoid bone grafting can be applied to stage Ⅰ patients.For stage Ⅱ and Ⅲ patients,wrist arthroscopy-assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone is helpful to facilitate bone healing,relieve pain,and improve function.