关节镜下自体骨移植经皮内固定治疗腕舟骨骨不连的临床疗效  

Arthroscopic bone grafting with percutaneous fixation in treating scaphoid nonunion

作　　者：赵喆[1] 何百昌[2] 谢永廉[2] 刘建全[1] 李永胜[1] 陈小强 王光辉[1] 程翔宇 尹建文 李嘉贝 李文翠[1] Zhao Zhe;HO. Pak Cheong;TSE. Wing Lim;Liu Jianquan;Li Yongsheng;Chen Xiaoqiang;Wang Guanghui;Cheng Xiangyu;Yin Jianwen;Li Jiabei;Li Wencui(Department of Peripheral Nerve,Hand and Foot Surgery,Shenzhen Second Peoples' Hospital (the First Affiliated Hospital of Shenzhen University),Shenzhen 518035,China;Department of Orthopaedic & Traumatology,Prince of Wales Hospital,Hong Kong 999077,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)周围神经手足外科,518035 [2]香港中文大学威尔斯亲王医院矫形外科与创伤学系,999077

出　　处：《中华骨科杂志》2019年第11期699-706,共8页Chinese Journal of Orthopaedics

基　　金：深圳市卫计委医疗卫生三名工程项目(SZSM201612086);深圳市卫生健康委员会学科建设能力提升项目(SZXJ2018065).

摘　　要：目的探讨关节镜下自体骨移植经皮内固定治疗腕舟骨骨不连的临床疗效。方法2013年5月至2017年8月收治25例腕舟骨骨不连患者,男20例,女5例;年龄(35.80±2.41)岁(18~65)岁。受伤至手术时间(11.70±1.90)个月(5~18)个月。均为单侧舟骨腰部及近端骨折,X线片和CT提示断端骨质硬化、吸收,无骨痂通过,无严重的畸形及腕关节炎,腕桡侧疼痛、乏力。Slade-GeisslerⅢ级4例、Ⅵ级13例、Ⅴ级7例、Ⅵ级1例。25例患者均行关节镜下清创、骨折断端新鲜化及自体髂骨移植,16例以克氏针固定、9例以空心螺钉固定。比较手术前后腕部疼痛视觉模拟评分(visual analogue scale,VAS)、腕关节屈伸活动度、握力及改良Mayo腕关节评分。结果全部病例获得随访,随访时间(18.59±2.41)个月(13~37个月)。经X线片及CT证实断端骨痂通过即骨性愈合,愈合时间(10.24±2.10)周(6~20周),无一例出现骨不连。末次随访时,VAS评分由术前(6.75±1.10)分降低至(1.33±0.21)分;腕关节屈伸活动度由术前135.24°±17.47°(正常侧的79.80%)提高至168.48°±12.41°(正常侧的92.90%);握力由术前(35.68±3.81)kg(正常侧的80.46%)提高至(48.75±4.42)kg(正常侧的90.65%);改良Mayo腕关节评分由术前(61.52±6.32)分提高至(85.88±8.37)分。结论关节镜下自体骨移植经皮内固定治疗腕舟骨骨不连创伤小,能最大程度地保留骨折端血运,减少并发症发生,促进骨折愈合,术后早期腕关节功能恢复良好。Objective To analyze the clinical effects of arthroscopic autologous bone grafting and percutaneous fixation in treating scaphoid nonunion.Methods From May 2013 to August 2017,a total of 25 cases of patients including 20 males and 5 females with unilateral scaphoid fractures and nonunion were reviewed,with mean age of 35.80±2.41 years(18-65 years).The duration from injury to treatment was averaged 11.70±1.90 months(5-18 months).All of the cases sustained waist and proximal end fractures.X-ray and CT scan showed sclerosis and bone resorption without any callus at the fracture sites.However,there were no serious deformities and wrist arthritis.The patients suffered pain and weakness at the radial side of the wrist.The type of the fractures were Slade-Geissler's III-VI,including grade III 4 cases,grade IV 13 cases,grade V 7 cases and grade VI 1 case.The patients were treated with arthroscopic debridement of the sclerotic bone,autologous bone grafting,percutaneous screw(9 cases)or K-wires fixation(16 cases)and immobilization by plaster for 3 weeks after operation,followed by functional rehabilitation training.Bone union was assessed by serial plain radiographs and CT scan regularly.The functional effects were evaluated by comparing the modified Mayo wrist score with the visual analogue scale(VAS)for pain,range of motion(ROM)and the grip strength,which were measured before operation and at 18 months after operation.Results All cases were followed up.Bone union was achieved in all of 25 nonunion.The average radiological union duration was 10.24±2.10 weeks(6-20 weeks).The average VAS score decreased from 6.75±1.10 preoperatively to 1.33±0.21.The mean ROM of wrist was improved to 168.48°±12.41°(92.90%of that of the normal side),compared to that of 135.24°±17.47°preoperatively(79.80%of that of the normal side).The mean grip strength showed improvement from an average of 35.68±3.81 kg(80.46%of that of normal side)preoperatively to 48.75±4.42 kg(90.65%of that of normal side).The average modified Mayo wrist scor

关 键 词：关节镜检查 骨移植 舟骨 骨折 不愈合 骨折固定术 内 

分 类 号：R687.4[医药卫生—骨科学]