计算机辅助设计个体化腕舟骨重建：指导经皮空心钉置入内固定修复  

Computer-assisted design of scaphoid reconstruction: individualized percutaneous cannulated screw fixation

作　　者：林旭[1] 曾俊[1] 郭勇[1] 谭伦[1] 

机构地区：[1]自贡市第四人民医院骨科,四川省自贡市643000

出　　处：《中国组织工程研究》2014年第44期7178-7182,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前计算机辅助设计个体化经皮穿针空心螺钉置入内固定和石膏管型外固定均被应用于治疗无移位腕舟骨骨折,但两种治疗方式的疗效尚未明确。目的:对比分析计算机辅助设计个体化经皮空心螺钉置入内固定和石膏外固定修复HerbertⅠb型腕舟骨骨折的临床效果。方法:将36例新鲜HerbertⅠb型腕舟骨骨折患者分成两组,计算机辅助设计个体化经皮空心螺钉置入内固定组(简称螺钉组)20例,石膏外固定组(简称石膏组)16例。螺钉组根据治疗前制定的个体化置钉参数,经皮自舟骨结节钻入0.8 mm导针,C臂透视导针方向,满意后经皮拧入合适Herbert螺钉。石膏组腕关节桡偏掌屈位石膏管型固定3个月。随访记录两组患者骨折愈合时间、骨不愈合率、恢复工作时间和腕关节活动度,并进行对比。结果与结论:患者随访10-24个月。螺钉组20例全部骨性愈合,平均愈合时间6周;石膏组13例骨性愈合,平均愈合时间14周,3例骨不愈合,两组比较差异有显著性意义(P<0.001)。恢复工作时间螺钉组平均7.6周,石膏组16.8周,两组差异有显著性意义(P<0.001)。末次随访时腕关节掌屈+背伸活动范围螺钉组为96.4°-114.4°,平均104.4°;石膏组66.4°-104.2°,平均94.2°,两组差异有显著性意义(P<0.001)。提示计算机辅助设计个体化经皮空心螺钉置入内固定修复HerbertⅠb型腕舟骨骨折具有创伤小,置钉准确性高,可重复性强的优势,修复效果明显优于石膏外固定。BACKGROUND：Individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization are common methods for treating nondisplaced wrist scaphoid fracture. However their clinical outcomes are stil unclear. OBJECTIVE：To compare the clinical results of individualized percutaneous cannulated screws fixation with the help of computer-assisted design and cast immobilization for treatment of Herbert type Ib scaphoid fracture. METHODS：A total of 36 patients with fresh Herbert type Ib scaphoid fracture were divided into two groups, individualized percutaneous cannulated screws fixation with the help of computer-assisted design group （screw group, 20 cases） and cast immobilization group （cast group, 16 cases）. In the screw group, cannulated screws were inserted using 0.8 mm kirschner wires from scaphoid tuberosity based on the preoperative individualization fixation parameters. The direction of the wires was guided under C-arms and Herbert screws were percutaneously immobilized after fluoroscopy. In the cast group, radial deviation and palmar flexion plaster casts were immobilized for 3 months. The time of bone union, rate of bone nonunion, time return to work, wrist motion were recorded and compared in the fol ow-up. RESULTS AND CONCLUSION：Al cases were fol owed for 10-24 months. Al patients in the screw fixation group and 13 out of 16 patients in the cast group achieved bone union. The average time of bone union of the two groups was 6 weeks and 14 weeks respectively （P〈0.001）. The time of returning to work was 7.6 weeks and 16.8 weeks respectively, with significant differences between the two groups （P〈0.001）. The range of motion of screw fixation group at the final fol ow-up was 96.4°-114.4°, average 104.4°, which was significantly higher than that in the cast group （66.4°-104.2°, average 94.2°;P〈0.001）. Individualized percutaneous cannulated screws fixation with the help of computer-assisted design can provide mini-invasion, high

关 键 词：植入物 数字化骨科 舟骨骨折 计算机辅助设计 微创 个体化 经皮 临床研究 

分 类 号：R318[医药卫生—生物医学工程]