舟骨、月骨骨折和（或）脱位的疗效分析  

Analysis of the treatment results of scaphoid and lunate bone fracture with （or） dislocation

作　　者：张颖[1] 路来金[1] 宫旭[1] 崔建礼[1] 孙希光[1] 蒋子平[1] 余欣[1] 

机构地区：[1]吉林大学第一医院手足外科,长春130021

出　　处：《中华骨科杂志》2015年第2期183-188,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨舟骨、月骨骨折和（或）脱位的诊断和治疗效果.方法 收集2005年1月至2013年12月收治并获得随访的舟骨、月骨骨折和（或）脱位患者的病历资料,按照纳入及排除标准共77例患者纳入研究进行回顾性分析.男64例,女13例;年龄15～73岁,平均31.9岁.单纯骨折41例,骨折合并脱位32例,单纯脱位4例.按治疗方式分为保守治疗组（9例）和手术治疗组（68例）,手术治疗组再依术式（加压螺钉固定术、克氏针固定术、近排腕骨切除术和月骨切除＋头状骨移位术）分为4个亚组.术后1、3、6、12个月及超过24个月进行的末次随访进行疗效评价,临床评估采用改良Mayo腕功能评分,影像学评估采用腕关节正、侧位X线片观察骨折愈合情况及腕关节稳定性.结果 77例患者均获得随访,随访时间6个月～8年,平均3年5个月.保守治疗的9例患者中4例骨折未愈合再次行手术治疗并纳入手术治疗组.手术治疗组中加压螺钉固定36例、克氏针固定34例、近排腕骨切除1例、月骨切除＋头状骨移位1例.加压螺钉组骨折愈合时间平均为6.1周,克氏针固定组为7周.根据改良Mayo腕功能评价标准,优51例（66.2％）、良11例（14.3％）、可9例、差6例,优良率为80.5％.加压螺钉固定组治愈率为97％,克氏针固定组治愈率为85％,两组治愈率的差异有统计学意义.术后舟骨骨折畸形愈合4例,畸形程度不重且仅1例背曲畸形的患者为优势手,经对症处理后腕痛症状消失.1例舟骨陈旧性骨折合并经舟骨、月骨周围性脱位患者术后出现腕关节不稳定,18周后行桡、舟、头韧带紧缩术,再次术后Mayo评分为优.结论 腕关节正、侧位X线片是舟骨、月骨骨折和（或）脱位的常用检查方法,但易误诊、漏诊,须加摄特殊体位.治疗应以手术为主,宜根据骨折和（或）脱位的具体情况选择相应术式,加压螺钉固定术的治疗效果优势较明显.Objective To analysis the clinical diagnosis and treatment of the scaphoid and lunate bone fracture with （or） wrist dislocation.Methods A retrospective analysis of the clinical data included 77 cases,which got admitted according to the inclusion and exclusion criteria and followed up completely from 2005 to 2013.In this group,there were 64 males and 13 females whose age arranged from 15 to 73 with a mean age of 31.9.There were 41 cases of simple fracture,32 cases of bone fracture with dislocation and 4 cases of simple dislocation.Treatment of cases was divided into the conservative treatment group （9 cases） and the surgery group （68 cases）.The surgery group was further divided into four subgroups according to surgical method （i.e.compression screw fixation,Kirschner wire fixation,proximal row of carpal resection,and lunate excision head shaped bone transposition）.Clinical outcome was evaluated based on modified Mayo wrist score and X-ray.Results All of 77 patients were followed up completely.Follow-up time arranged from 6 months to 8 years,with an average follow-up time of 3 years and 5 months.9 cases were treated conservatively.In the surgical treatment group,there were 36 cases of compression screw fixation,34 cases of Kirschner wire fixation,1 case of proximal row of carpal resection and 1 case of the lunate bone resection heads transposition.The average healing time of compression screw group was 6.1 weeks and the Kirschner group was 7 weeks.According to the modified Mayo wrist score,excellent：51 cases （66.2%）,good：11 cases （14.3%）,fair：9 cases,and poor：6 cases.The rate of excellent and good was 80.5%.The cure rate of compression screw treatment was 97%,and 85% of Kirschner.The difference of cure rate was statistically significant.After surgery,there were four cases that got scaphoid malunion.The degree of deformity was not serious with only one case happened in the dominant hand,and the wrist pain got better after symptomatic treatment.1 case of scaphoid fracture with dislocat

关 键 词：舟骨 月骨 骨折 脱位 内固定器 

分 类 号：R687.3[医药卫生—骨科学]