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Percutaneous Treatment of Unstable Scaphoid Waist Fractures

机译:不稳定的舟骨腰椎骨折的经皮治疗

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Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoid fractures, although less information has been reported about outcomes for unstable, displaced fractures. The aim of this study was to evaluate the union and complication rates following manual closed reduction and percutaneous screw placement for a consecutive series of unstable, displaced scaphoid fractures. Methods: A total of 28 patients (average age, 27 years; 22 male/6 female) were treated for isolated unstable displaced scaphoid waist fractures. Closed reduction and percutaneous headless, compression screw fixation was successfully performed in 14 patients (average age, 32 years; 10 male/4 female), and the remaining 14 patients required open reduction. Patients who underwent percutaneous treatment were followed for radiographic fracture union and clinical outcomes. Results: Thirteen of 14 fractures (93%) had clinical and radiographic evidence of bone union at an average of 2.8 months postoperatively. Average visual analog pain score at the time of union was 0.9. The average Quick Disability of the Arm, Shoulder, and Hand score at 2.5 years follow-up (range, 1.5-8.3 years) was 9.6 (range, 0.0-27.3). Complications included 1 case of nonunion and 1 case of intraoperative Kirschner wire breakage. Conclusions: Manual closed reduction followed by percutaneous headless, compression screw fixation was possible in 50% of patients who presented with acute unstable, displaced scaphoid fractures. This technique appears to be a safe and effective method when a manual reduction is possible, and it may offer a less invasive option when compared with a standard open technique.
机译:背景:尽管未报道不稳定的移位性骨折的结局信息,但已报道了经皮技术用于治疗非移位的舟骨骨折。这项研究的目的是评估连续一系列不稳定,移位的舟骨骨折的人工闭合复位和经皮螺钉置入后的联合和并发症发生率。方法:总共28例患者(平均年龄27岁;男22例,女6例)接受了孤立的不稳定移位舟骨腰椎骨折治疗。 14例患者(平均年龄32岁;男性10例,女性4例)成功进行了闭合复位和经皮无头加压螺钉固定,其余14例患者需要复位复位。对接受了经皮治疗的患者进行影像学检查骨折愈合和临床结果。结果:14例骨折中有13例(93%)平均在术后2.8个月具有骨结合的临床和影像学证据。合并时的平均视觉模拟疼痛评分为0.9。在2.5年的随访中(1.5-8.3年),手臂,肩膀和手部的平均快速残疾评分为9.6(0.0-27.3)。并发症包括1例骨不连和1例术中克氏针断裂。结论:50%的急性不稳定,移位的舟骨骨折患者中,可以进行手动闭合复位,然后经皮无头,加压螺钉固定。当可以进行手动复位时,该技术似乎是一种安全有效的方法,并且与标准开放式技术相比,它可以提供侵入性较小的选择。

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