桡骨远端楔形截骨术治疗腕舟状骨不愈合及月骨坏死  

Distal Radius Wedge Osteotomy for Nonunion Old Scaphoid Fracture and Kienbock's Disease

作　　者：孙继飞[1] 刘振利[1] 陈庆胜[1] 刘晓伟[1] 高岩[1] 

机构地区：[1]解放军第251医院骨二科,张家口075000

出　　处：《中国现代手术学杂志》2010年第6期455-457,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的 评价桡骨远端楔形截骨术治疗腕舟状骨不愈合和月骨坏死的效果.方法 应用桡骨远端楔形截骨术治疗腕舟状骨不愈合123例和月骨坏死32例.术中第一截骨线在桡骨茎突近端1.5 cm处,截骨方向与桡骨远端关节面平行;第二截骨线位于第一截骨线近端0.5～1.0 cm处,截骨方向与桡骨纵轴垂直;两截骨线在下尺桡关节中心会合.取出楔形骨块,桡偏使楔形截骨处对合,用1或2枚克氏针固定.结果 术后平均随访25（6～60）个月.腕舟状骨折均愈合,平均愈合时间10（8～14）周.32例月骨坏死者中,13例硬化骨重新成活,余无明显改善.术后腕关节疼痛VAS评分、腕关节活动度及握力均较术前明显改善（P〈0.05）;术后患侧腕关节活动度与握力与健侧比较无统计学差异（P〉0.05）. 99例手功能正常,56例有轻微功能障碍.腕关节功能按Krimmer评分：优99例,良56例.结论 桡骨远端楔形截骨术治疗腕舟状骨不愈合及月骨坏死的效果确切,操作简单,是值得推荐的一种有效方法.Objective To evaluate the effect of distal radius wedge osteotomy for nonunion old scaphoid fracture and Kienbock＇s disease.Methods 123 patients with nonunion old scaphoid fracture and 32 patients with Kienbock＇s disease were treated by distal radius wedge osteotomy.During operation,the first line of osteotomy was located in 1.5 cm of proximal radial malleolus and the direction of osteotomy was parallel to the distal radial articular surface;The second line of osteotomy was located in 0.5 to 1.0 cm of proximal first line of osteotomy and the direction of osteotomy is vertical to longitudinal axis of radius.The two lines of osteotomy met in the centre of distal radioulnar joint.Then,cuneate bone were removed,osteotomies sections were reset by radial deviation and following fixed with one or two kirschner wires.Results All 155 patients were followed up for 6 to 60 months with average of 25 months.All scaphoid fractures healed in average 10 weeks（ranged from 8 to 14 weeks）.Out of 32 cases with Kienbock＇s disease,sclerotic lunate bone was reactive in 13 cases and not obvious improved in other 19 cases.The postoperative visual analogue scales（VAS） of wrist joint,activity of wrist joint and grip strength were remarkable improved than those of pre-operation（P0.05）.There was no statistic difference in wrist joint activity and grip strength between uninjured side and injured side（P0.05）.The normal hand function was restored in 99 cases and mild dysfunction in 56 cases.According Krimmer wrist joint function scale,the results revealed excellence in 99 and good in 56 cases.Conclusion The distal radius wedge osteotomy is an effective method for nonunion old scaphoid fracture and Kienbock＇s disease with reliable effect and simple procedure,and it is worth recommending.

关 键 词：截骨术 手骨 骨坏死 

分 类 号：R687.3[医药卫生—骨科学]