Zusammenfassung
Einleitung: Basis der kritischen Analyse der derzeitigen Wiederherstellungsverfahren bei Skaphoidpseudarthrose ist eine klinisch retrospektive Untersuchung zweier Patienten Kollektive.
Methode: 55 Patienten wurden bei Skaphoidpseudarthrose mit dem Verfahren nach Matti-Russe operiert und durchschnittlich 10,7 Jahre postoperativ nachuntersucht. Diese Daten wurden 43 Patienten (Nachuntersuchungszeit: 11,0 Jahre) die mit Spongiosaplastik und Herbertschraube operiert wurden gegenübergestellt.
Ergebnisse: In dem Matti-Russe-Kollektiv waren bei 69% der Patienten degenerative Veränderungen des Karpus neu aufgetreten, überwiegend im fortgeschrittenen Arthrosestadium. Bei 38% bestand eine Fehlform des Kahnbeins und in 18% eine DISI-Deformität. Mehr als die Hälfte der Patienten wiesen eine Bewegungseinschränkung auf. In dem Herbertschrauben Kollektiv war in 21% zum Zeitpunkt der Nachuntersuchung eine überwiegend beginnende Arthrose feststellbar. Eine Skaphoidfehlform lag in 7% und eine DISI-Fehlstellung in 5% vor. Eine postoperative Bewegungseinschränkung bestand nur anteilig.
Diskussion: Die Spongiosaplastik in Kombination mit interner Stabilisierung stellt das Standardverfahren zur Therapie einer Skaphoidpseudarthrose dar. Der korrekten Wiederherstellung der Skaphoidform kommt eine übergeordnete Bedeutung zu.
Abstract
Introduction: Currently performed surgical procedures for scaphoid nonunion were evaluated on the basis of a retrospective study of two different treatment groups.
Method: 55 patients with scaphoid nonunion were evaluated clinically and radiologically on average 10.7 years after the Matti-Russe procedure. The Matti-Russe group was compared to a group of 43 patients with scaphoid nonunion who received bone grafting and Herbert screw fixation with an average follow up of 11.0 years
Results: 69% of all patients of the Matti-Russe group developed mostly advanced osteoarthritis of the carpus. In 38% a malunion of the scaphoid was and in 18% a DISI-deformity was found. The majority of patients after Matti-Russe procedure experienced limitations concerning the range of motion. At time of follow up, only 21% of the patients treated with the Herbert screw suffered from an osteoarthritis of the carpus, mainly in an initial stadium. A scaphoid malunion was found in 7% and a DISI-deformity in 5% of the patients. A minority of the Herbert screw group presented a decreased range of motion at follow up.
Discussion: Internal fixation and bone grafting is currently the gold standard in the surgical treatment of scaphoid nonunions. The correct reconstruction of the scaphoid shape is crucial for the outcomes.
Schlüsselwörter
Skaphoidpseudarthrose - Matti-Russe - Herbertschraube - Arthrose - Handgelenk
Key words
scaphoid non-union - Herbert screw - osteoarthritis - long-term - wrist
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Korrespondenzadresse
PD Dr. med. W. Daecke
Klinikum der Johann-Wolfgang Goethe-Universität
Unfall-, Hand- und Wiederherstellungs-chirurgie
Marienburgerstraße 2
60258 Frankfurt/M
Email: Wolfgang.Daecke@kgu.de
