Trephineを用いた舟状骨偽関節手術

Modified Leung's Trephine Bone Grafting Technique for Scaphoid Nonunion

　背景：舟状骨偽関節に対して楔状骨移植術は広く用いられる術式であるが，手技的には必ずしも容易ではない．Leungらは初めて舟状骨偽関節に対してtrephineを用いた術式を報告した．本調査の目的は，Leungらの術式に小改変を加えて，その術後成績を調査することにあった．

　方法：Trephineを舟状骨偽関節部に存在する瘢痕組織や壊死骨の掻爬および円柱形の移植骨の採取に用いた．Leungらとは異なって，移植骨を腸骨翼ではなく腸骨稜から採取した．

　結果：平均で15カ月の経過観察を行い，DASH score・健側比較力・健側比可動域・Cooney scoreはそれぞれ5点，91％，89％，83点であった．

　まとめ：本調査の結果はLeungらのそれと同等であり，小改変を加えたLeungらの術式は舟状骨偽関節手術に対して有効であることを示している．

　Background：Although the wedge-shaped bone graft technique is a well established surgical treatment for scaphoid nonunion, some authors have pointed out that the technique is the quite difficult.　Leung et al. were the first apply trephines to the surgical treatment of scaphoid nonunion.　The purpose of the present study was to assess the Leung technique with a minor modification.

　Methods：The trephines were used to curette scar tissue and necrotic bone located at the site of nonunion and to core up the cylindrical corticocancellous bone graft from the iliac crest.　In contrast to the procedure described by Leung et al., the bone graft was obtained from the iliac not from the iliac wing.

　Result：The average follow-up period was 15 months.　The average of DASH, and the grip strength and the range of montion as compare to the unaffected, Cooney score was 5, 91%, 89% and 83, respectively.　Preoperative and postoperative raduolunate angle was 9 degrees and 5 degrees volar, respectively.

　Conclusion：The results of the current study was compatible with those of Leung et al. and show that the Leung technique with a minor modification results in improved outcomes of the surgical treatment for scaphoid nonunion.