新型导向器用于经皮螺钉固定治疗舟状骨骨折  

Percutaneous screw fixation with a novel guide for the treatment of scaphoid fractures

作　　者：白江博[1] 高瑞姣 张阿茹 于昆仑[1] 张春欢 田德虎[1] Bai Jiangbo;Gao Ruijiao;Zhang Aru;Yu Kunlun;Zhang Chunhuan;Tian Dehu(Department of Hand Surgery,Third Hospital of Hebei Medical University,Shijiazhuang 050051,Hebei Province,China;Office of Academic Research,Third Hospital of Hebei Medical University,Shijiazhuang 050051,Hebei Province,China)

机构地区：[1]河北医科大学第三医院手外科,河北省石家庄市050051 [2]河北医科大学第三医院科研处,河北省石家庄市050051

出　　处：《中国组织工程研究》2024年第12期1885-1889,共5页Chinese Journal of Tissue Engineering Research

基　　金：河北省医学科学研究重点课题(20180440),项目负责人:白江博。

摘　　要：背景:舟状骨骨折是临床上常见的腕部骨折,主要采用经皮螺钉治疗,首先闭合复位骨折端,然后将空心加压螺钉精准置于舟状骨轴心并加压固定骨折端,能够促进骨折愈合,使腕关节获得良好功能。目的:评价一种新型克氏针导向器辅助经皮空心加压螺钉治疗舟状骨骨折的临床疗效。方法:回顾性分析2015年1月至2020年12月河北医科大学第三医院手外科收治的15例舟状骨骨折患者的临床资料。所有患者均采用新型导向器辅助经皮空心加压螺钉固定治疗。统计患者的骨折愈合时间、手术时间、透视次数、重返工作的时间及并发症。术后12个月采用改良Mayo腕关节评分对腕关节功能进行评估,测量患侧及健侧腕关节掌屈、背伸、尺偏、桡偏活动度及握力。结果与结论:所有患者均完成了12个月随访。术后X射线片示:空心压力螺钉位于舟状骨轴心位置。所有舟状骨骨折均获骨性愈合,平均愈合时间10.0周。手术平均历时55.7 min,术中平均透视次数10.9次,平均10.3周重返工作岗位。腕关节功能:优9例,良5例,可1例,优良率93.3%。患侧及健侧的腕关节掌屈、背伸、尺偏、桡偏活动度及握力相比较,差异无显著性意义(P>0.05)。所有患者均未发生伤口感染、骨折畸形愈合、螺钉松动及断裂等并发症。结果表明,应用新型导向器可以缩短手术时间,减少术中透视次数,提高螺钉精准度,缩短重返工作时间,腕关节功能恢复良好。该导向器使空心加压螺钉治疗舟状骨骨折手术更容易。BACKGROUND:Scaphoid fractures are common wrist fractures.The percutaneous screw is used to treat scaphoid fractures.The closed reduction of the fracture site,the precise placement of the hollow compression screw in the scaphoid axis and the compression fixation of the fracture site can promote fracture healing and achieve the better function of the wrist.OBJECTIVE:To evaluate the efficacy of percutaneous hollow compression screw fixation of scaphoid fractures using a novel Kirschner wire guide.METHODS:Between January 2015 and December 2020,clinical data from 15 patients with scaphoid fractures selected at the Department of Hand Surgery,Third Hospital of Hebei Medical University were retrospectively analyzed.All patients underwent percutaneous hollow compression screw fixation by a novel Kirschner wire guide.Fracture healing time,operation time,number of intraoperative fluoroscopies,time to return to work and complications were collected.According to the modified Mayo wrist scoring system,the functional outcomes of wrists were assessed 12 months after surgery.Wrist flexion,extension,ulnar deviation,radial deviation and grip strength were measured.RESULTS AND CONCLUSION:All patients were followed up for 12 months.The compression screw was located in the axial position of the scaphoid by routine immediate postoperative radiographs.All scaphoid fractures united at an average of 10.0 weeks.The average operation time was 55.7 minutes.The number of intraoperative fluoroscopies was 10.9.The average time to return to work was 10.3 weeks.The results of wrist joint function were excellent in 9 cases,good in 5 cases,and average in 1 case,with an excellent and good rate of 93.3%.No significant differences in wrist flexion,extension,ulnar deviation,radial deviation and grip strength were found between the affected and healthy sides(P>0.05).None of the patients had wound infection,malunion,screw displacement,or screw breakage.These findings indicate that the application of a novel guide can shorten the operation time,reduce the

关 键 词：舟状骨骨折 空心加压螺钉 导向器 腕关节功能 骨折愈合时间 并发症 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.4