Analysis Of Surgical Efficacy Of Two Different Bone Grafts Combined With Herbert Screw Internal Fixation In The Treatment Of Carpal Scaphoid Nonunion

Objective:This article will retrospectively analyze the clinical efficacy of two different bone grafting methods combined with Herbert screw internal fixation in the treatment of 20 cases of carpal scaphoid nonunion,in order to provide clinical basis and clinical ideas for the treatment of carpal scaphoid nonunion with Herbert screw internal fixation.Methods:Twenty patients with scaphoid bone nonunion treated with Two different bone grafts combined with Herbert screw internal fixation in our hospital from February 2011 to December 2018 were collected as study subjects.Surgical methods:Pure bone grafting is used in cases without proximal ischemic necrosis,or used bone transplantation with blood supply.Radial styloid process is assisted in cases with severe wrist radial pain.For resection,Herbert screws were used for all internal fixation materials.Evaluation methods:The patients were followed up regularly after surgery.The fracture healing status was determined by wrist CT.The results of the postoperative assessment included the healing time of the fracture,the patient’s return to work and exercise ability,and the wrist function score before and after surgery(Mayo score),Visual analog scoring(VAS score)and the shortened Disabilities of the Arm,Shoulder,and Hand questionnaire(DASH questionnaire),SPSS 18.0 software was used to analyze the differences between postoperative and preoperative in Mayo score,DASH questionnaire score and VAS score,as well as the differences in postoperative fracture healing time and Mayo score between smoking and non-smoking patients.Result:The average age of the 20 patients was 33.6 years,and the average time from the first injury to our hospital was 16.7 months.The average follow-up time of all patients was 26.3 months,and all patients obtained bone healing after the surgery,with an overall average healing time of 4.6 months,and the average healing time of long-term smoking patients was 5.7 months,The overall excellent rate of wrist joint function reached 70%.The grip strength increased from 51.4%before operation to an average of 86.1 after operation.The wrist mobility increased from 68±13.3° before,operation to 99.9±18.1± after operation.Mayo score of wrist was increased from 47.8±7.3 before operation Raised to 84.8±15.0 after operation,the score of the DASH questionnaire was reduced from 35.1±6.5 before operation to 10.5±9.5 after operation,and the VAS method was reduced from 7.0±2.8 before operation to 2.1±1.3 after operation.The Mayo score increased from 47.8±7.3 before surgery to 84.8±15.0 after surgery,and the DASH score decreased from 35.1±6.5 before surgery to 10.5±9.5.The difference between postoperative and in Mayo score,DASH questionnaire score and VAS score was statistically significant(P<0.05).The difference between smoking patients and non-smoking patients in fracture healing time was statistically significant(P<0.05)and there was no statistically significant difference in the recovery of wrist joint function(P>0.05).Conclusion:Open bone grafting combined with Herbert screw internal fixation in the treatment of carpal scaphoid nonunion had good healing rate,Wrist function recovered satisfactorily.