应用注射器针导引掌侧经皮Bold空心螺钉固定腕舟骨骨折  

Volar percutaneous Bold screw fLxation of scaphoid fractures using a syringe needle guide

作　　者：傅重洋[1] 丁晖原 赵巍[1] 蒋华军[1] 曲巍[1] 

机构地区：[1]大连医科大学附属第一医院手显微外科,116011

出　　处：《中华手外科杂志》2014年第3期188-190,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨利用50ml注射器针作为导向器掌侧经皮3．0mmBold空心螺钉固定腕舟骨骨折的临床疗效。方法选择2006年7月至2011年3月治疗的腕舟骨骨折患者24例。骨折根据Herbert分型为A2型3例，B1型2例，B2型11例，C型骨折5例，D1型3例。术中C臂机透视定位，用50ml注射器针经舟骨多角骨关节穿刺，到达舟骨远极骨面。C臂机透视确定注射器针轴线与舟状骨轴线一致，经其打入导针。测深后旋入直径3．0mm Bold空心螺钉。术后腕关节石膏固定2周，循序渐进行功能锻炼。结果所有患者均获得随访，平均15个月（6～24个月）。1例D1型骨折患者骨折未愈合，经再次植骨内固定处理后愈合。其余患者骨折平均愈合时间为18周（8～32周）。所有患者术后均无感染、瘢痕形成、创伤性关节炎及血管神经损伤等并发症。根据Cooney腕关节评分系统，平均得分为91．4分（76～100分）；优14例、良8例、可2例，优良率为91．7％。结论利用注射针作为导向器掌侧经皮Bold空心螺钉固定腕舟骨骨折，使导针打人更加容易、准确，操作更加简便；内固定安全有效，切口小，软组织剥离少，是治疗HerbertA2、B1、B2、C型腕舟骨骨折的理想术式。Objective To evaluate the clinical outcomes of scaphoid fracture fixation with a 3.0 mm Bold cannulated screw via volar percutaneous approach guided by a 50 ml syringe needle. Methods Twenty- four patients with scaphoid fractures surgically treated between July 2006 and March 2011 were enrolled in this study. According to Herbert＇s classification, there were 3 type A2, 2 type B1, 11 type B2, 5 type C and 3 type D1 fractures. Under C-ann fluoroscopy monitoring, a 50 ml syringe needle was placed into the distal pole of the scaphoid via the seaphotrapezial joint and adjusted to be aligned with the scaphoid axis. Then the guide wire was advanced across the fracture through the syringe needle cannula. The syringe needle was withdrawn while the depth of the screw was measured. A 3.0 mm Bold cannulated screw was introduced along the guide to hold and compress the two fracture segments. A wrist cast was applied for two weeks after which mobilization exercises were gradually carried out. Results All patients were follow-up for a mean period of 15 months （range, 6 to 24 months）. One case of type D1 fracture suffered fracture nonunion and was subsequently cured by reoperation with bone grafting and internal fixation. All the other fractures healed with an average bone union time of 18 weeks （range, 8 to 32 weeks）. No infection, scar formation, traumatic arthritis or vascular nerve injury occurred during follow-up. The Cooney wrist score averaged 91.4 （range, 76 to 100）. The functional result was ranked as excellent in 14 patients, good in 8 patients and fair in 2 patients. The excellent and good rate was 91.7%. Conclusion Volar percutaneotts Bold cannulated screw fixation is an ideal choice for Herbert type A2, B1, B2 and C scaphoid fractures because it is safe and effective and causes little scar and minimum soft tissue dissection. Utilizing a 50 ml syringe needle as guidance makes the guide wire insertion more easy, accurate and convenient.

关 键 词：舟骨 骨折 注射器针 掌侧 经皮固定 空心螺钉 

分 类 号：R687.3[医药卫生—骨科学]