关节镜与开放式植骨融合固定治疗不稳定型舟骨骨不连的疗效分析  

Analysis of the curative effect of arthroscopic and open ankle arthrodesis in the treatment of unstable scaphoid nonunion

作　　者：许梅辛 孙兴霞[2] 刘洋[1] 常亮 XU Mei-xin;SUN Xing-xia;LIU Yang(Department of Orthopedic Trauma II,First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Harbin Heilongjiang 150040,China;Department of Community Medicine Section,Fourth Affiliated Hospital of Harbin Medical University,Harbin Heilongjiang 150010,China)

机构地区：[1]黑龙江中医药大学附属第一医院骨伤二科,黑龙江哈尔滨150040 [2]哈尔滨医科大学附属第四医院社区医学科,黑龙江哈尔滨150010

出　　处：《临床和实验医学杂志》2021年第20期2185-2189,共5页Journal of Clinical and Experimental Medicine

基　　金：哈尔滨市科技厅项目(项目编号2018JT004);2019年黑龙江省自然基金资助项目(QC2019101)。

摘　　要：目的分析关节镜与开放式植骨融合固定治疗不稳定型舟骨骨不连的疗效。方法选取2014年2月至2018年6月黑龙江中医药大学附属第一医院收治的不稳定型舟骨骨不连(USN)患者76例,回顾性分析其临床资料,根据不同治疗方法,将患者分为关节镜组40例,开放组38例,关节镜组接受关节镜下植骨融合固定治疗,开放组接受开放式植骨融合固定治疗,随访2年,比较2组手术指标及骨折愈合情况,握力与腕关节活动度,SLA、RLA、LISA及HLR值,腕关节功能评分优良率,视觉模拟疼痛评分(VAS)、上肢功能障碍量表(DASH)评分及并发症。结果关节镜组手术时间显著长于开放组,差异有统计学意义(P<0.05);2组手术费用、骨折愈合时间、愈合率比较,差异无统计学意义(P>0.05)。术后,2组握力与腕关节活动度较本组术前明显提高,差异有统计学意义(P<0.05),2组组间比较差异无统计学意义(P>0.05)。关节镜组腕关节功能优良率为95.00%,开放组为81.58%,2组比较差异无统计学意义(P>0.05)。术前,2组VAS评分、DASH评分比较差异无统计学意义(P>0.05),术后,2组VAS评分、DASH评分较本组术前明显下降(P<0.05),关节镜组VAS评分、DASH评分明显低于开放组,差异有统计学意义(P<0.05)。术后,2组SLA、RLA、LISA及HLR显著下降,差异均有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。关节镜组无并发症发生,开放组术后感染和神经损伤各1例。结论关节镜植骨融合固定治疗USN,能促进骨折愈合,改善腕关节功能,与开放式植骨融合术疗效相当,其虽然手术时间较长,但其可更有效减轻术后疼痛,降低致残情况。Objective To compare the efficacy of arthroscopic and open ankle arthrodesis in the treatment of unstable scaphoid nonunion(USN).Methods A total of 76 USN patients in First Affiliated Hospital,Heilongjiang University of Chinese Medicine from February 2014 to June 2018 were enrolled,and their clinical date were retrospectively analyzed.Patients were divided into two groups according to different treatment methods;40 underwent arthroscopic ankle arthrodesis(arthroscopic group),and 38 underwent open ankle arthrodesis(open group).During the 2-year follow-up,various indexes were compared between groups,including surgical indicators,fracture healing,grip strength,wrist mobility,SLA,RLA,Lisa and HLR values,wrist function score,Visual Analogue Scale score(VAS),Disability of Arm Shoulder and Hand(DASH)score and complications.Results The operation time of arthroscopic group was significantly longer than that of open group,the difference was statistically significant(P<0.05),while no significant difference was found in operation cost,fracture healing time and healing rate between the two groups(P>0.05).After operation,the grip strength and wrist mobility were increased in both groups,the differences were statistically significant(P<0.05),while comparison between groups showed no statistic difference(P>0.05).The excellent rate of wrist joint function was 95.00%in arthroscopic group and 81.58%in open group,with no significant difference(P>0.05).Scores of VAS and DASH had no significant difference between groups before operation(P>0.05),which were decreased in both groups after operation(P<0.05),and were lower in arthroscopic group than in open group,the differences were statistically significant(P<0.05).After operation,SLA,RLA,Lisa and HLR decreased significantly,the differences were statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).There were no complications in arthroscopic group,while one case of postoperative infection and nerve injury occurred in open group.Conclusio

关 键 词：不稳定型舟骨骨不连 关节镜植骨融合术 开放式植骨融合术 疗效 

分 类 号：R687.3[医药卫生—骨科学]