经皮腕掌侧入路内固定治疗腕舟骨骨折

摘要

Objective To evaluate the clinical outcomes of scaphoid fracture fixation with double-thread screw via volar percutaneous approach. Methods We retrospectively evaluated 17 wrists of 17 patients(16 males,1 female;mean age 25 years,range 17 ~ 44)who underwent volar percutaneous fixation with double-thread screw for acute scaphoid fractures between 2010 and 2014. The left side was involved in 8 cases and the right in 9. Fractures were assessed by X-ray and CT scan and separated into B1(2 cases)and B2(15 cases)according to Herbert. Types of trauma were sports injury(7,41% ),accidental falls(6,35% )and road accident(4 cases,24% ). All patients were operated within 3 ~ 12 days of injury with an average of 6 days. All patients were assessed according to Mayo wrist score postoperatively. X-ray check-ups were made 4,6 and 12weeks after surgery. Fractures were considered as consolidated when X-ray check-ups showed the significant presence of trabeculation crossing the fracture,without pain. Results Mean operative time were 27(range:20 ~ 35)minutes. There was no tendon or vascular nerve damage in any of the patients during surgery. 16 patients'follow-up duration was 13. 5(range:6 ~ 20)months. All the patients healed with an average bone union time of 8. 5(range,8 ~ 13)weeks postoperatively. Results using the Mayo wrist score showed a mean score of 95. 31(range 75 ~ 100). In particular,12 fractures(75% )got excellent results(score 90~ 100),three(18. 75% )good(80 ~ 89)and one(6. 25% )fare(65 ~ 79). The small volar incision of all patients were healed by the first intention. No cases of infection,necrosis or hypertrophic scarring were found during follow-up. Conclusion Percutaneous fixation with double-thread screw via volar approach is a valuable treatment method for scaphoid fractures with the advantages of mini-invasion strong compress at fracture site,high bone union rate and the wrist function recoverd well.%目的：探讨经皮腕掌侧入路双头加压螺钉内固定治疗舟骨骨折的临床疗效。方法回顾性分析2010年至2014年间经皮腕掌侧入路双头加压螺钉内固定治疗舟骨骨折17例，男16例，女1例；年龄17~44岁，平均25岁；左侧8例，右侧9例。术前均行 X 线及 CT 检查，骨折按 Herbert 分型，B1型2例，B2型15例。受伤类型：体育运动中损伤7例（41%），坠落伤6例（35%），交通事故伤4例（24%）；受伤至手术时间3~12 d，平均6 d。依据 Mayo 腕关节功能评分标准对术后患者进行评价。术后4周、6周及12周复查 X 线片，疼痛消失且 X 线示骨折断端有明显骨小梁形成视为骨愈合。结果手术时间20~35 min，平均27 min；术中无肌腱及神经血管损伤。16例患者获随访，随访时间6~20个月，平均13.5个月；骨折愈合时间8~13周，平均8.5周。术后 Mayo 评分75~100分，平均95.31分，其中12例优（90~100分），3例良（80~89分），1例可（65~79分）。所有患者腕掌侧小切口Ⅰ期愈合，随访期内无感染、骨坏死或瘢痕形成病例。结论经皮腕掌侧入路双头加压螺钉内固定治疗舟骨骨折是一种有效的手术方法，切口微创、断端加压固定、骨愈合率高，腕关节功能恢复良好。