外固定支架联合Herbert螺钉及克氏针固定治疗陈旧性经舟骨月骨周围脱位  

External Fixator Combined with Herbert Screw and Kirschner Wire Fixation for Old Trans-scaphoid Perilunate Dislocation

作　　者：谢峰林 黄泽林 杨俊涛 李浩 段梦娴 向仁堃 刘辉成 XIE Feng-lin;HUANG Ze-lin;YANG Jun-tao;LI Hao;DUAN Meng-xian;XIANG Ren-kun;LIU Hui-cheng(Department of Hand & Foot Surgery, the Second Hospital, University of South China, Hengyang 421000, Hunan, China;Department of Academic Affairs, Hengyang Campus of Changsha Medical College, Hengyang 421000, Hunan, China)

机构地区：[1]南华大学附属第二医院手足外科,湖南衡阳421000 [2]长沙医学院衡阳校区教务处,湖南衡阳421000

出　　处：《中国现代手术学杂志》2022年第2期120-123,共4页Chinese Journal of Modern Operative Surgery

基　　金：湖南省卫生健康委科研计划课题项目(C2019103)。

摘　　要：目的探讨外固定支架联合Herbert螺钉及克氏针固定治疗陈旧性经舟骨月骨周围脱位的临床效果。方法回顾性分析2007年1月至2020年3月手术治疗的12例陈旧性经舟骨月骨周围脱位患者的临床资料,其中左手4例,右手8例;伴正中神经损伤1例,桡骨茎突骨折1例。受伤至手术时间平均(5.5±1.1)周。均采用外固定支架联合Herbert螺钉及克氏针固定骨折及脱位。结果所有患者术后随访12~15个月,平均(13.0±0.4)个月。11例舟骨骨折均骨性愈合,未见舟骨及月骨坏死,腕骨无脱位;1例出现舟骨缺血坏死,后期行带血管蒂骨瓣移植后骨愈合。末次随访,腕关节掌屈57.3°±4.7°、背伸54.5°±3.5°,桡偏15.6°±2.3°,尺偏24.1°±3.8°;采用Gartland-Werley评分评价腕关节功能:优9例,良1例,可1例,差1例,优良率83.3%(10/12)。结论外固定支架联合Herbert螺钉及克氏针固定治疗陈旧性经舟骨月骨周围脱位,可促进韧带早期修复,加快腕关节功能恢复,临床疗效可靠,并发症少,值得临床推广。Objective To explore the clinical effect of external fixator combined with Herbert screw and Kirschner wire fixation in the treatment of old trans-scaphoid perilunate dislocation(TSPD).MethodsThe clinical data of 12 patients with old TSPD treated in our hospital from January 2007 to March 2020 were analyzed retrospectively,including 4 cases of left hand and 8 cases of right hand.Among them,one case combined with median nerve injury and one case with radial styloid fracture.The average time of injury was(5.5±1.1)weeks.External fixator combined with Herbert screw and Kirschner wire fixation was applied to fix the fracture and dislocation.Results All patients were followed up for 12 to 15 months(mean 13.0±0.4 months).Out of them,scaphoid fractures union was achieved in 11 patients without scaphoid and lunate bone necrosis and carpal dislocation;avascular necrosis of scaphoid was found in one patient and healed after vascular pedicled bone flap grafting.At the last follow-up,the angle of metacarpal flexion,dorsal extension,radial deviation and ulnar deviation was 57.3°±4.7°,54.5°±3.5°,15.6°±2.3°and 24.1°±3.8°respectively.Postoperative wrist joint function of Gartland-Werley score showed excellence in nine cases,good in one case,fair in one case and poor in one case,and the excellent and good rate was 83.3%(10/12).Conclusion External fixator combined with Herbert screw and Kirschner wire fixation can achieve reliable efficacy with repairing the ligament early,promoting the recovery of wrist function quickly and reducing complications,which is worthy of clinical generalization.

关 键 词：骨折固定术 外固定支架 经舟骨月骨周围脱位 

分 类 号：R683.41[医药卫生—骨科学]