不同置钉方法空心螺钉内固定治疗新鲜腕部舟状骨骨折的临床研究

摘要

目的 比较不同置钉方法空心螺钉内固定(hollow screw internal fixation,HSIF)治疗新鲜腕部舟状骨骨折(scaphoid fracture,SF)的临床疗效.方法 2013年7月-2015年6月于成都医学院第一附属医院行HSIF治疗的SF新鲜骨折患者78例,其中男性48例,女性30例;年龄17~50岁,平均年龄39.77岁;骨折原因:摔伤32例,道路交通伤30例,运动损伤13例,其他3例.依据随机数字表法将78例SF新鲜骨折患者分为实验1组和实验2组各39例.实验1组行近极向远极HSIF,实验2组行远极向近极HSIF.观察两组骨折愈合情况、恢复工作时间,术前及术后6个月腕关节活动情况及术后6个月Cooney腕关节评分.结果 实验1组骨性愈合率(89.74%)高于实验2组(74.36%),骨折愈合时间(9.89 ±1.17)周、恢复工作时间(11.27 ±1.38)周均小于实验2组[(13.76 ±1.68)周、(15.92 ±1.85)周],P<0.05.术后,实验1组腕关节活动指标均大于实验2组,P<0.05.术后,实验1组各项Cooney腕关节得分及总分均高于实验2组, P<0.05.实验1组优良率(92.31%)高于实验2组(76.92%),P<0.05.结论 近极向远极HSIF治疗SF新鲜骨折患者可有效保护局部血供,促进骨性愈合,改善腕关节功能,疗效显著.%Objective To compare the clinical efficacy of different nailing methods of hollow screw internal fixation(HSIF)in treating fresh carpal scaphoid fracture(SF).Methods A total of 78 patients with fresh SF treated by HSIF from Jul.2013 to Jun.2015 in our hospital were selected and divided into experimental group 1 and experimental group 2 according to the random number table method,with 39 cases in each group.Among them 48 were male and 30 were female with an average age of 39.77(17-50)years.Thirty-two cases were injured from falling,30 were injured from road traffic accidents,13 were from sports injury and 3 were from other reasons.Pa-tients in experimental group 1 were performed proximal-pole to distal-pole HSIF,and those in experimental group 2 were performed distal-pole to proximal-pole HSIF.The fracture healing state,work recovery time,carpal joint motion state 6 months before and after the operation and Cooney wrist joint scores 6 months after the operation of the two groups were observed.Results The fracture healing rate(89.74%)in experimental group 1 was higher than that in experimental group 2(74.36%),and the fracture healing time and work recovery time((9.89 ±1.17)weeks, (11.27 ±1.38)weeks)were less than those in experimental group 2((13.76 ±1.68)weeks,(15.92 ±1.85) weeks,P<0.05).After operation,the indexes of carpal joint motion in experimental group 1 were larger than those in experimental group 2(P<0.05).Each item's score and aggregate score of Cooney wrist joint in experimental group 1 were higher than those in experimental group 2(P<0.05).The excellent and good rate in experimental group 1(92.31%)was higher than that in experimental group 2(76.92%,P<0.05).Conclusion Proximal-pole to distal-pole HSIF in treating patients with fresh SF can effectively protect local blood supply,promote bony u-nion and improve wrist joint function,and the curative effect is significant.