Herbert螺钉微创掌侧入路和背侧入路治疗Herbert Ⅰb型腕舟骨骨折远期临床疗效及预后比较  

Comparison of long-term clinical efficacy and prognosis of patients with Herbert type Ⅰb carpal scaphoid fractures treated by Herbert screw minimally invasive volar approach and dorsal approach

作　　者：穆卫庐[1] 常军英[1] 贾东昭[1] 付强[1] 冯建书[1] 侯卫星[1] 王彦志[1] 李炎[1] 邢兆国[1] 李琦军[1] MU Weilu;CHANG Junying;JIA Dongzhao;FU Qiang;FENG Jianshu;HOU Weixing;WANG Yanzhi;LI Yan;XING Zhaoguo;LI Qijun(Department of Traumatology and Orthopedics,the Third Hospital of Shijiazhuang,Shijiazhuang 050011,Hebei Province,China)

机构地区：[1]石家庄市第三医院创伤骨科,河北石家庄050011

出　　处：《新乡医学院学报》2021年第12期1166-1170,共5页Journal of Xinxiang Medical University

基　　金：河北省医学科研重点课题计划项目(编号:20150169)。

摘　　要：目的比较Herbert螺钉微创掌侧入路和背侧入路治疗HerbertⅠb型腕舟骨骨折患者的远期临床疗效及预后。方法选择2014年1月至2016年3月石家庄市第三医院收治的37例HerbertⅠb型腕舟骨骨折患者为研究对象,按随机数字表法分为掌侧组(n=19)和背侧组(n=18)。掌侧组患者采用掌侧经皮Herbert螺钉微创治疗,背侧组患者采用背侧经皮Herbert螺钉微创治疗。评估2组患者手术后3 a的临床疗效,并计算临床疗效优良率。采用改良Mayo腕关节功能评分法评估2组患者手术前及手术后3 a的腕关节功能。采用角度计测量2组患者手术前及手术后3 a的腕关节活动情况,包括腕关节掌屈、背伸、桡偏、尺偏活动角度。记录2组患者腕骨骨折愈合时间、手术结束至重返工作岗位时间。手术后随访3 a,观察并记录随访期间2组患者并发症发生情况。结果手术后3 a,背侧组患者临床疗效优良率为88.89%(16/18),掌侧组患者临床疗效优良率为94.74%(18/19),2组患者临床疗效优良率比较差异无统计学意义(χ^(2)=0.424,P>0.05)。2组患者手术后3 a的疼痛程度、功能状态、活动范围、握力及总评分均显著高于术前(P<0.05);手术前、手术后3 a,掌侧组患者疼痛程度、功能状态、活动范围、握力及总评分与背侧组比较差异均无统计学意义(P>0.05)。2组患者手术后3 a的腕关节掌屈、背伸、桡偏、尺偏活动范围均显著高于术前(P<0.05);手术前、手术后3 a,掌侧组患者腕关节掌屈、背伸、桡偏、尺偏活动范围与背侧组比较差异均无统计学意义(P>0.05)。掌侧组患者骨折愈合时间和手术后至重返工作岗位时间均显著低于背侧组(P<0.05)。随访期间,2组患者均未发生感染、骨不连、舟骨坏死、神经损伤、螺钉松动等并发症,仅背侧组中有1例患者出现轻度疼痛症状,活动受限,但握力良好,经辅助治疗腕关节功能恢复良好。结论掌侧经皮Herbert螺�Objective Comparison of the long-term clinical efficacy and prognosis of patients with Herbert type Ⅰb carpal Scaphoid fractures treated by Herbert screw minimally invasive volar approach and dorsal approach.Methods A total of 37 patients with Herbert type Ib carpal scaphoid fracture admitted to the Third Hospital of Shijiazhuang from January 2014 to March 2016 were selected as the research objects, and they were divided into volar group(n=19) and dorsal group(n=18) according to the random number table method.The patients in the volar group received minimally invasive treatment with volar percutaneous Herbert screws, and the patients in the dorsal group received minimally invasive treatment with dorsal percutaneous Herbert screws.Three years after operatien, the clinical efficacy of patients in the two groups was evaluated, and the rate of excellent and good of clinical efficacy was calculated.The wrist function of patients before and three years after operation in the two groups was evaluated by the modified Mayo wrist function scoring method.The wrist joint activities including wrist flexion, back extension, radial deviation and ulnar deviation of patients before and three years after the operation in the two groups were measured by the goniometers.The time of carpal fracture healing and the time from the end of operation to returning to work of patients in the two groups were recorded.The postoperative follow-up was conducted for three years, and the complications of patients in the two groups during the follow-up period were observed and recorded.Results Three years after operation, the excellent and good rate of clinical efficacy of patients in the dorsal group was 88.89%(16/18),and the excellent and good rate of patients in the volar group was 94.74%(18/19).There was no significant difference in the excellent and good rate of clinical efficacy of patients between the two groups(χ^(2)=0.424,P>0.05).The pain degree, functional status, range of motion, grip strength and total scores of patients in the two g

关 键 词：腕舟骨骨折 HerbertⅠb型 HERBERT螺钉 掌侧入路 远期疗效 

分 类 号：R658.2[医药卫生—外科学]