镍钛记忆合金腕骨四角融合器应用于腕塌陷的疗效观察  

The outcomes of NiTi shape memory alloy four-corner arthrodesis concentrator for carpal collapse

作　　者：徐永清[1] 齐保闯[1] 朱跃良[1] 徐小山[1] 陆声[1] 李军[1] 丁晶[1] 覃励明[1] 

机构地区：[1]成都军区昆明总医院附属骨科医院,昆明650032

出　　处：《中华骨科杂志》2011年第3期219-223,共5页Chinese Journal of Orthopaedics

基　　金：全军医药卫生科研基金资助项目（06MA140）;军队临床高新技术重大项目任务书（2010gxjs041）

摘　　要：目的 评价应用镍钛记忆合金腕骨四角融合器（NiTi shape memory alloy four-corner arthrodesis concentrator,NTMA-FCAC）治疗腕塌陷（carpal collapse）的效果.方法 2006年8月至2009年6月,应用NTMA-FCAC行头骨、月骨、三角骨及钩骨四角融合并舟骨切除术治疗13例腕塌陷患者,男8例,女5例;年龄23～61岁,平均38岁;右手9例,左手4例.其中陈旧性舟骨骨折不愈合致腕塌陷7例,陈旧性经舟骨、月骨周围脱位致腕塌陷5例,舟月进行性腕塌陷1例.随访内容包括术后患手握力、腕关节活动范围、腕关节疼痛程度、腕关节X线检查.采用疼痛视觉模拟评分（visual analogue scale,VAS）评估腕关节疼痛程度.采用Krimmer腕关节评分对腕关节总体功能进行评价.结果 术后随访6～36个月,平均26.5个月.术后平均握力为（32.49±6.21）kg,恢复至健侧的80.8%;术后腕关节活动范围达到健侧的53%以上.X线检查未见骨不连及伤口感染.腕关节VAS评分：休息状态下术前为（4.46±1.27）分,术后为（1.31±0.95）分;负重状态下术前为（7.00±1.41）分,术后为（2.62±1.26）分;两种状态下术前及术后比较,差异均有统计学意义.Krimmer腕关节评分为79分.术后优良率为84.6%.结论 应用NTMA-FCAC进行四角融合术能保存大部分腕关节功能,是治疗腕塌陷的有效办法.Objective To evaluate the results of NiTi shape memory alloy four-corner arthrodesis concentrator （NTMA-FCAC） for carpal collapse. Methods We reviewed retrospectively 13 patients who underwent scaphoid excision with four-corner arthrodesis using NTMA-FCAC for carpal collapse from August 2006 to June 2009. There were eight males and five females, with an average age of 38 years （range, 23-61years）. The cause of carpal collapse was SNAC in 7 cases, perilunate dislocations in five and SLAC in one.The injury mechanisms included traffic accidents （5 cases）, falling from a height （4 cases）, crashes （3 cases）and sprain （1 case）. Objective measurements included grip strength and range of the wrist. Radiographs were performed in all patients. A visual analogue scale （VAS） was used to assess wrist pain. The results were evaluated according to the Krimmer wrist scores. Results The mean follow-up time was 26.5 months （range,6-36 months）. Clinical evaluation yielded the mean grip strength of （32.49±6.21） kg （80.8% of opposite side）.The mean range of the wrist reached over 53% of the healthy side. Non-union and wound infection were not seen. The mean VAS scores had improved from 4.46±1.27 preoperatively to 1.31 ±0.95 postoperatively. The mean pain scores under stress had improved from 7.00±1.41 preoperatively to 2.62±1.26 postoperatively.There were remarkable differences between them. The mean Krimmer wrist score was 79. Conclusion Four-corner arthrodesis using NTMA-FCAC is an effective method for carpal collapse, preserving a majority of wrist function.

关 键 词：腕关节 镍 钛 骨关节炎 关节融合术 

分 类 号：R687.3[医药卫生—骨科学]