Retrograd Fiksasyon ve Vaskülerize Olmayan Kansellöz Kemik Otogrefti ile Tedavi Edilen Proksimal Kutup Skafoid Kaynamamasının Uzun Dönem Sonuçları

Abstract

Amaç: Skafoid kemik proksimal kutup kaynamama tanısı almış olan ve volar yaklaşımla distal radiusdan nonvaskülarize kanselloz otogreft ve bir adet kanüllü, başsız vida ile retrograd fiksasyon uygulanan hastaların uzun dönem klinik ve fonksiyonel sonuçlarını değerlendirmektir. Gereç ve Yöntemler: Bu çalışmada skafoid proksimal kutup kaynamama tanısı ile cerrahi yapılan, 2 kadın ve 27 erkek olmak üzere yirmi dokuz hasta değerlendirildi. Tüm hastalara volar yaklaşımla distal radiustan nonvaskülarize kanselloz otogreft ve bir adet başsız kanüllü vida ile retrograd fiksasyon yapıldı ve aynı rehabilitasyon programı uygulandı. Hastaların klinik ve fonksiyonel skorları cerrahi öncesi ve son kontrolde değerlendirildi. Bulgular: Hastaların ortalama yaşı 30,66±7,34 (aralık, 18-40) yıl idi. Ortanca semptom süresi 11 (aralık, 6-18) ay ve cerrahi sonrası ortanca takip süresi 55 (aralık, 36-67) ay idi. Son kontrolde sağlam ve cerrahi uygulanan tarafların ön kol kaslarının maksimum izometrik kuvveti değerlendirildiğinde, sağlam tarafın ortalama el kavrama gücü test değerleri patolojik tarafa göre anlamlı derecede daha yüksekti (p<0,001). Buna ek olarak, son kontrolde el bilek eklem hareket açıklığı açısından sağlam tarafın ortalama fleksiyon ve radial deviasyon değerlerinin cerrahi uygulanan tarafa göre istatistiksel olarak anlamlı derecede daha yüksek olduğu bulundu (sırasıyla p=0,006 ve p=0,022). Sonuç: Skafoid kemik proksimal kutup kaynamama durumunda, volar yaklaşımla nonvaskülarize kanselloz otogreft ve retrograd fiksasyon etkili bir cerrahi tedavi seçeneğidir.

Keywords

• Skafoid kaynamaması
• proksimal kutup
• retrograd fiksasyon
• nonvaskülerize kansellöz kemik otogrefti

Long-term Results of Proximal Pole Scaphoid Nonunion Treated with Retrograde Fixation and Non-vascularized Cancellous Bone Autograft

Abstract

Aim: To evaluate the long-term clinical and functional results of patients diagnosed with scaphoid bone proximal pole nonunion and who underwent retrograde fixation with non-vascularized cancellous autograft from the distal radius and a cannulated, headless screw via a volar approach. Material and Methods: Twenty-nine patients, 2 female, and 27 male, who underwent surgery with the diagnosis of scaphoid proximal pole nonunion were evaluated in this study. All patients underwent retrograde fixation with a non-vascularized cancellous autograft from the distal radius and a headless cannulated screw using a volar approach and the same rehabilitation program was applied. The clinical and functional scores of the patients were evaluated before surgery and at the last follow-up. Results: The mean age of the patients was 30.66±7.34 (range, 18-40) years. The median symptom duration was 11 (range, 6-18), and the median follow-up period after surgery was 55 (range, 36-67) months. When the maximum isometric strength of the forearm muscles of the healthy and surgical sides was evaluated at the last follow-up, the mean hand-grip strength test values of the healthy side were significantly higher than the pathological side (p<0.001). In addition, the mean flexion and radial deviation values of the healthy side were found to be statistically significantly higher than the surgical side in terms of the wrist joint range of motion at the last follow-up (p=0.006, and p=0.022, respectively). Conclusion: Non-vascularized cancellous autograft and retrograde fixation with a volar approach is an effective surgical treatment option for proximal pole nonunion of the scaphoid bone.

Keywords

• Scaphoid nonunion
• proximal pole
• retrograde fixation
• non-vascularized cancellous bone autograft

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