经皮双螺钉内固定不植骨技术治疗腕舟骨骨折延迟愈合或不愈合  

Application of percutaneous double screw fixation without bone grafting for the treatment of delayed union or nonunion of scaphoid fractures

作　　者：郭阳[1] 马炜 童德迪[1] 刘坤[1] 杨辰[1] Guo Yang;Ma Wei;Tong Dedi;Liu Kun;Yang Chen(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopedics,PLA Air Force General Hospital,Beijing 100142,China)

机构地区：[1]北京积水潭医院手外科,北京100035 [2]中国人民解放军空军总医院骨科,北京100142

出　　处：《中华手外科杂志》2022年第2期81-85,共5页Chinese Journal of Hand Surgery

摘　　要：目的评估使用经皮双螺钉内固定不植骨技术治疗舟骨骨折延迟愈合或不愈合的临床效果。方法我科自2018年1月至2019年2月对20例舟骨骨折延迟愈合或不愈合的患者,通过骨科机器人技术辅助下或徒手经皮置入两枚空心螺钉进行内固定,对骨折端不进行植骨。所有患者至少术后1年进行随访,并收集其临床和影像学资料。收集并对比术前和随访时的VAS评分、Mayo腕关节评分、握力和关节活动度等各项数据。结果受伤到手术时间平均为6.8个月(3~12个月),所有病例在术后8.55周时达到骨愈合(6~12周)。在术后随访时,影像学检查均未发现螺钉侵犯舟骨远端或舟骨结节皮质等内固定并发症出现,所有病例的VAS评分、关节活动度、Mayo评分、握力等均较术前有明显提升,所有患者均可回归受伤前正常的日常生活。结论与传统手术方式相比,采用经皮双螺钉内固定不植骨技术治疗舟骨骨折延迟愈合或不愈合,内固定稳定性好、手术创伤小、骨折愈合迅速,可以获得更良好的功能恢复。Objective To evaluate the clinical efficacy of percutaneous double screw fixation without bone grafting for the treatment of delayed union or nonunion of scaphoid fractures.Methods From January 2018 to February 2019,20 patients with delayed union or nonunion of scaphoid fractures were treated with internal fixation by percutaneous placement of two cannulated screws with the assistance of orthopedic robot technology or bare hands,and the fracture end was not grafted.All the patients were followed up at least 1 year after operation,and their clinical and imaging data were collected.The visual analogue scale(VAS),Mayo wrist score,grip strength and joint range of motion(ROM)were collected and compared before operation and at follow-up.Results The average time from injury to operation was 6.8 months(ranged,3 to 12 months).All the cases achieved bone healing at 8.55 weeks(ranged,6 to 12 weeks).During postoperative follow-up,imaging examination did not find internal fixation complications such as screw invasion of the distal scaphoid or the cortex of scaphoid tubercle.The VAS,ROM,Mayo score and grip strength of all the cases were significantly improved compared with those before operation.All the patients could return to their normal daily life.Conclusion Compared with the traditional surgical method,the application of percutaneous double screw internal fixation without bone grafting for the treatment of delayed union or nonunion of scaphoid fractures has better stability of internal fixation,less surgical trauma,more rapid fracture healing and better functional recovery.

关 键 词：舟骨 骨折 延迟愈合 经皮内固定 骨科机器人辅助手术 

分 类 号：R687.3[医药卫生—骨科学]