经皮双头加压螺钉内固定与克氏针内固定治疗腕部舟状骨骨折的疗效比较  

Percutaneous double head compression screw internal fixation and K-wire internal fixation in the treatment of scaphoid fractures of the wrist

作　　者：何志 王诗峰 高欣 谢金峰 周子凡 范爱民 He Zhi;Wang Shifeng;Gao Xin;Xie Jinfeng;Zhou Zifan;Fan Aimin(Department of Orthopedics,Zhenjiang 359 Hospital,Zhenjiang,Jiangsu 212000,China)

机构地区：[1]镇江三五九医院骨科,江苏镇江212000

出　　处：《创伤外科杂志》2023年第2期124-128,135,共6页Journal of Traumatic Surgery

基　　金：江苏省自然科学基金面上项目(BK20201235)。

摘　　要：目的比较经皮双头加压螺钉内固定与克氏针内固定治疗腕部舟状骨骨折(scaphoid fracture,SF)的效果。方法前瞻性研究2017年2月—2021年2月镇江三五九医院SF患者78例,男性46例,女性32例;年龄29~63岁,平均40.2岁。按照随机数字表法分为克氏针组和加压螺钉组,各39例。克氏针组采用克氏针内固定治疗,加压螺钉组采用经皮双头加压螺钉内固定治疗。比较两组患者手术时间、术中出血量、骨折愈合时间,根据骨与关节疗效评估标准评估术后6个月疗效及腕关节功能(Cooney腕关节评分),并比较并发症发生情况。结果加压螺钉组手术时间、术中出血量分别为(45.7±6.8)min、(18.9±3.4)mL,克氏针组(47.1±6.9)min、(19.2±3.3)mL,两组患者比较差异无统计学意义(P>0.05);加压螺钉组骨折愈合时间(9.5±1.6)周短于克氏针组(12.5±1.8)周(P<0.05);加压螺钉组优良率92%(36/39)高于克氏针组74%(29/39)(P<0.05);加压螺钉组Cooney腕关节评分[功能(21.7±3.2)分、疼痛(22.1±3.1)分、活动范围(20.5±3.4)分、活动度(21.4±2.4)分、旋转(23.1±1.9)分、握力(20.8±2.6)分]高于克氏针组[(16.9±3.0)分、(17.8±2.9)分、(15.9±2.7)分、(17.3±2.2)分、(21.0±1.7)分、(17.5±2.4)分](P<0.05);加压螺钉组并发症发生率11%(4/39),克氏针组18%(7/39),组间比较差异无统计学意义(P>0.05)。结论与克氏针内固定相比,经皮双头加压螺钉内固定治疗SF疗效显著,能缩短骨折愈合时间,改善腕关节功能,且安全性较高。Objective To compare the therapeutic effect of percutaneous double head compression screw internal fixation and K-wire internal fixation for scaphoid fractures(SFs)of the wrist.Methods Patients with SFs in Zhenjiang 359 Hospital from Feb.2017 to Feb.2021 were prospectively selected and randomly(random number table)divided into K-wire group and compression screw group.During the study period,78 cases were included,with 39 cases in each group.The K-wire group was treated by K-wire internal fixation and the compression screw group by percutaneous double head compression screw internal fixation.The operation time,intraoperative blood loss and fracture healing time were recorded.The therapeutic effect at 6 months after surgery and wrist function assessed by Cooney wrist score were compared between two groups,as well as the incidence of complications.Results The operation time and intraoperative blood loss in the compression screw group were(45.7±6.8)min and(18.9±3.4)mL,similar to that in the K-wire group,respectively(47.1±6.9)min and(19.2±3.3)mL(both P>0.05).The fracture healing time(weeks)was shorter in the compression screw group(9.5±1.6 vs.12.5±1.8,P<0.05),with a higher good-excellent rate[92%(36/39)vs.74%(29/39),P<0.05].The Cooney wrist score was also better in the compression screw group in terms of each item:function(21.7±3.2 vs.16.9±3.0),pain(22.1±3.1 vs.17.8±2.9),movement range(20.5±3.4 vs.15.9±2.7),range of motion(21.4±2.5 vs.17.3±2.2),rotation(23.1±1.9 vs.21.0±1.7),grip strength(20.8±2.6 vs.17.5±2.4,P<0.05).The incidence of complications was 11%(4/39)in the compression screw group and 18%(7/39)in the K-wire group,revealing no significant difference(P>0.05).Conclusion Compared with K-wire internal fixation,percutaneous double head compression screw internal fixation is more effective in the treatment of SFs,which shortens the fracture healing time and improves the functions of the wrist joint,and moreover with a high safety.

关 键 词：腕部舟状骨骨折 经皮双头加压螺钉内固定 克氏针内固定 疗效 

分 类 号：R683.41[医药卫生—骨科学]