镍钛记忆合金两脚固定器联合自体松质骨移植治疗舟骨陈旧性骨折并骨不连  

Nitinol memory alloy two foot fixator with autologous cancellous bone grafting for old scaphoid fracture and nonunion

作　　者：宋慕国 何晓清 李川[1] 徐永清[1] SONG Muguo;HE Xiaoqing;LI Chuan;XU Yongqing(Department of Orthopaedics,the 920th Hospital of Joint Logistic Support Force of Chinese PLA,Kunming Yunnan,650032,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第920医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2020年第6期676-682,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省钟世镇院士工作站项目(2015IC030)。

摘　　要：目的总结镍钛记忆合金两脚固定器联合自体松质骨移植治疗舟骨陈旧性骨折并骨不连疗效。方法2013年1月-2017年1月,应用镍钛记忆合金两脚固定器联合自体松质骨移植治疗11例舟骨陈旧性骨折并骨不连患者。患者均为男性;年龄18~42岁,平均26.1岁。致伤原因:运动伤3例,摔伤7例,重物砸伤1例。受伤至手术时间6~18个月,平均8.9个月。通过手术时间、骨折愈合时间、握力、腕关节活动度(屈曲、背伸、尺偏、桡偏),以及Mayo评分、疼痛视觉模拟评分(VAS)以及上臂、肩、手功能障碍评分(DASH)评价临床疗效。结果手术时间35~63 min,平均48 min。术后切口均Ⅰ期愈合,无感染、内固定物松动及断裂等并发症发生。患者均获随访,随访时间12~30个月,平均20.7个月。X线片检查骨折均愈合,愈合时间为12~25周,平均15周。所有患者内固定物于术后10~12个月取出,平均11.2个月。末次随访时,患侧握力以及腕关节屈曲、桡偏、尺偏活动度均较术前明显改善,差异有统计学意义(P<0.05);背伸活动度与术前比较差异无统计学意义(t=0.229,P=0.824);上述指标与健侧相比,差异均有统计学意义(P<0.05)。末次随访时,Mayo评分、VAS评分、DASH评分均较术前明显改善,差异有统计学意义(P<0.05)。结论镍钛记忆合金两脚固定器联合松质骨移植治疗舟骨陈旧性骨折并骨不连可获得较好疗效,可作为一种治疗选择。Objective To summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.Methods Between January 2013 and January 2017,11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting.All patients were male with an average age of 26.1 years(range,18-42 years).The fractures were caused by sport in 3 cases,falling in 7 cases,and a crashing object in 1 case.The interval between injury and operation was 6-18 months(mean,8.9 months).Postoperative outcome measures included operation time,fracture healing time,grip strength,range of motion(ROM)of flexion,extension,ulnar deviation,and radial deviation,Mayo score,visual analogue scale(VAS)score,and the Disabilities of the Arm,Shoulder,and Hand(DASH)score.Results The operation time was 35-63 minutes(mean,48 minutes).All incisions had primary healing with no infection and loosening or breakage of internal fixator.All patients were followed up 12-30 months(mean,20.7 months).X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks(range,12-25 weeks).All internal fixators were removed after 10-12 months of operation(mean,11.2 months).At last follow-up,the grip strength,ROMs of flexion,ulnar deviation,and radial deviation were superior to those before operation(P<0.05),no significant difference was found in ROM of extension between pre-and post-operation(t=0.229,P=0.824).There were significant differences in above indexes between affected and normal sides(P<0.05).At last follow-up,the Mayo,VAS,DASH scores were also significantly superior to those before operation(P<0.05).Conclusion For the old scaphoid fracture and nonunion,Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness,which is an effective treatment.

关 键 词：舟骨骨折 骨不连 镍钛记忆合金两脚固定器 骨移植 腕关节 

分 类 号：R687.3[医药卫生—骨科学]