两种内固定方式治疗腕舟骨骨折的临床疗效对比

摘要

Objective To compare the effectiveness of two types of internal fixation methods via palmar approach with compression screws fixation from the proximal pole and fixation from the distal pole in the treatment of scaphoid fractures. Methods Fifty-six scaphoid fractures were performed fixation via palmar approach with compression screws. All patients were divided into fixation from the proximal pole to the distal pole group( 29 patients, Group A )and fixation from the distal pole to the proximal pole group( 27 patients, Group B ). Time to union, and union rates were recorded. The results were evaluated using the clinical scoring system of Coon-ey. Results Twenty-five of Group A were healed at a median of( 11.71 ±1.65 )weeks, and twenty of Group B were healed at a median of ( 15. 59 ±1.73 )weeks. The rate of union was significantly higher ( P < 0. 05 ) and the median time to healing was significantly shorter ( P < 0. 05 ) for the scaphoid fractures treated with the fixation from the proximal pole. The outcome according to the clinical scoring system of Cooney standard Group A was excellent in 14, good in 10, fair in 3 , and poor in 2. The Group B was excellent in 13 , good in 7 , fair in 3 , and poor in 4. Conclusions A fixation from the proximal pole via palmar approach is the recommended internal fixation method for the surgical treatment of scaphoid fractures.%目的 比较腕掌侧入路加压螺钉由腕舟骨近极向远极固定和由远极向近极固定对腕舟骨骨折的临床疗效.方法 采用腕掌侧入路加压螺钉治疗56例腕舟骨骨折患者,按固定方式不同分为由腕舟骨近极向远极固定29例(A组),由腕舟骨远极向近极固定27例(B组).记录骨折愈合时间、愈合率.按Cooney评分标准评估腕关节功能.结果 A组有25例获得骨性愈合,愈合时间(11.7±1.65)周;B组有20例获得骨性愈合,愈合时间(15.6±1.73)周;两组比较差异有统计学意义(P<0.05).按Cooney评分标准:A组优14例,良10例,中3,差2例;B组优13例,良7例,中3例,差4例;两组比较差异有统计学意义(P<0.05).结论 在保护腕舟骨血供、促进骨折愈合及改善腕关节功能方面,腕掌侧入路加压螺钉由腕舟骨近极向远极固定优于由远极向近极固定.