CT引导下经皮Herbert螺钉微创治疗腕舟骨骨折21例报告  

CT-guided Percutaneous Minimally Invasive Treatment by Using Herbert Screws for Wrist Scaphoid Fracture: Report of 21 Cases

作　　者：孙勇伟[1] 张蜀华[1] 

机构地区：[1]山西医科大学第二医院综合骨科,太原030001

出　　处：《中国微创外科杂志》2014年第7期644-646,657,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨CT引导下经皮穿刺复位Herbert螺钉治疗腕舟骨骨折的疗效。方法2010年9月～2012年10月对21例腕舟骨骨折在CT引导下完成Herbert螺钉内固定。疗效评定包括骨折愈合、疼痛、握力和腕关节活动度，采用腕关节功能评分标准对患者自觉恢复情况进行评定。结果手术时间25～55 min，平均35．3 min；术中出血量8～40 ml，平均18．6 ml。骨折断端均获得骨性愈合，平均愈合时间10．4周（8～17周）。21例随访8～13个月，平均9．8月，末次随访：VAS评分（1．2±0．8）分，显著低于术前（5．3±1．4）分（t＝11．785，P＝0．000）；握力（39．6±3．5）kg，显著高于术前（19．4±2．4）kg （t＝-21．624，P＝0．000）；腕关节屈伸角度115．3°±7．4°，显著高于术前89．8°±10．4°（t＝-9．103，P＝0．000）；腕关节尺桡偏角度53．7°±5．5°，显著高于术前39．4°±3．4°（t ＝-10．116，P＝0．000）；腕关节功能优18例，良3例，优良率100％。结论在CT引导下经皮穿刺复位Herbert螺钉微创治疗腕舟骨骨折疗效满意。Objective To investigate therapeutic effects of CT-guided percutaneous minimally invasive treatment by using Herbert screws for wrist scaphoid fracture . Methods From September 2010 to October 2012, 21 patients with scaphoid fracture were treated by internal fixation by using Herbert screws under the guidance of CT .The results of the procedure were assessed in terms of osseous union , pain extent , grip strength , and active motion of the wrist .Postoperative outcomes were evaluated by wrist standard scores based on patients’ perception of functions. Results The operation time was 25 -55 min （mean, 35.3 min）.The intraoperative blood loss was 8-40 ml （mean, 18.6 ml）.Fracture fragments were cured with bone union , with an average healing time of 10.4 weeks （range, 8-17 weeks）.All the 21 cases were followed up for 8 -13 months （mean, 9.8 months）.The VAS scores at the last follow-up was （1.2 ±0.8） points, which was significantly lower than that before the operation （5.3 ±1.4） points （t=11.785, P=0.000）.The grip strength was （39.6 ±3.5） kg, which was significantly higher than that preoperatively [（19.4 ± 2.4） kg, t=-21.624, P =0.000].The Angle of wrist flexion and extension was 115.2°±7.4°, significantly higher than preoperative measure （89.8°±10.4°, t =-9.103, P =0.000）.The wrist ulnar radial deflection angle was 53.7°±5.5°, significantly higher than preoperative one （39.4°±3.4°, t =-10.116, P=0.000）.At the last follow-up assessment of wrist functions, excellent result was recorded in 18 cases, and good in 3 cases, with a good-or-excellent rate of 100%. Conclusion Treatment of scaphoid fracture with Herbert screws under the guidance of CT is a minimally invasive method , bearing advantages of little incision, simple operation performance , and good effects .

关 键 词：腕舟骨 HERBERT螺钉 

分 类 号：R687.3[医药卫生—骨科学]