经皮螺钉内固定治疗舟骨骨折114例随访结果  

Percutaneous fixation of scaphoid fractures: outcomes of 114 cases

作　　者：刘波[1] 陈山林[1] 田光磊[1] 朱瑾[1] 胡琪[1] 诸寅[1] 武竞衡[1] 杨辰[1] 荣艳波[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《骨科临床与研究杂志》2017年第1期17-23,共7页Journal Of Clinical Orthopedics And Research

基　　金：首都卫生发展科研专项项目(2011-2007-02);北京市"十百千"卫生人才"千"层次项目(2011)~~

摘　　要：目的介绍经皮螺钉内固定治疗舟骨骨折的适应证、手术方法和疗效。方法回顾分析2003年1月至2015年1月本文作者采用经皮加压螺钉内固定技术治疗的舟骨骨折病例170例。采用Mayo腕关节功能评分及患者自我评价腕关节问卷(patient-rated wrist evaluation,PRWE)对术后腕关节功能进行评价。结果 114例获得完整随访,其中掌侧入路91例,背侧入路23例。急性舟骨骨折(无腕关节脱位者)77例(无移位者57例,移位骨折20例),均在术后8周或12周X线显示骨折愈合;平均随访时间32(12~84)个月,未发现内固定移位、腕关节创伤性关节炎表现;Mayo腕关节功能评分均为优,平均PRWE评分为1.8分。急性经舟骨月骨周围骨折脱位26例,平均随访时间13(6~30)个月;Mayo腕关节功能评分13例优,8例良,4例中,1例差;平均PRWE评分为11分。延误诊治的舟骨骨折11例,平均随访时间为14(6~36)个月;其中6例进行了腕关节镜下微创植骨及经皮固定;所有患者均获得骨折愈合,平均愈合时间11(8~17)周;最终随访时Mayo腕关节功能评分10例为优,1例为良,平均PRWE评分为5.9分。结论经皮加压螺钉内固定治疗急性舟骨骨折或延误诊治的舟骨骨折近期随访结果满意,是一种有效的、值得考虑的治疗选择。Objective To introduce indication,surgical techniques and outcome of percutaneous screw fixation for acute and neglected scaphoid fractures. Methods We retrospectively reviewed 170 patients who had an acute or neglected scaphoid fracture treated with percutaneous screw fixation between January 2003 and January 2015. Results One hundred and fourteen patients had full follow-up data, with 91 palmar approach and 23 dorsal approach procedures. All 77 acute fractures （ without wrist joint dislocation） united at 8 or 12 weeks follow-up. The mean follow-up period was 32 months （range, 12 -84 months）. No sign of traumatic ar-thritis or other complications was observed. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in all patients. The mean Patient-Rated Wrist Evaluation （PRWE） score was 1.8. For 26 transscaphoid perilunate dislocations, the mean follow-up period was 13 months （range,6 -30 months）. The Mayo wrist score were rated as excellent in 13 patients, good in 8,fair in 4 and poor in 1. The mean PRWE score was 11. For 11 neglected scaphoid fractures, the average follow-up period was 14 months （ range, 6-36 months） . Six of the 11 patients received arthroscopically assisted percutaneous fixation with arthroscopic debridement and bone grafting. Union was achieved in all 11 patients at a mean of 11 weeks （range, 8-17 weeks）. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 10 patients and good in 1. Conclusions Percutaneous screw fixation is a reliable and favorable approach in the treatment of acute scaphoid fractures and scaphoid fractures with delayed diagnosis and treatment according to our early follow-up results.

关 键 词：舟骨 骨折 骨折固定术 内 腕 关节镜检查 

分 类 号：R687.32[医药卫生—骨科学]