双螺钉经皮内固定治疗腕舟骨骨折延迟愈合或不愈合的疗效分析  

Minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture

作　　者：荣存敏[1] 王芳[2] 赵振国[1] 曾俊豪 徐宝强 张清林[1] 朱少波 韩清銮[1] 郭阳 Rong Cunmin;Wang Fang;Zhao Zhenguo;Zeng Junhao;Xu Baoqiang;Zhang Qinglin;Zhu Shaobo;Han Qingluan;Guo Yang(Department of Hand and Foot Surgery,The Affiliated Hospital of Jining Medical University,Jining 272029,China;Pharmacy Intravenous Admixture Service(PIVAS),The Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]济宁医学院附属医院手足外科,济宁272029 [2]济宁医学院附属医院静脉用药调配中心,济宁272029 [3]首都医科大学附属北京积水潭医院手外科,北京100035

出　　处：《中华创伤骨科杂志》2025年第2期169-174,共6页Chinese Journal of Orthopaedic Trauma

基　　金：山东省医药卫生科技项目(202304070500);山东省专业学位研究生教学案例库建设项目(SDYAL21215);济宁市重点研发计划项目(2020JKNS010,2022YXNS047,2022YXNS062)。

摘　　要：目的探讨双螺钉经皮内固定治疗腕舟骨骨折延迟愈合或不愈合的临床疗效。方法回顾性分析2021年3月至2023年12月济宁医学院附属医院手足外科收治的12例舟骨骨折延迟愈合或不愈合的患者。男11例,女1例;年龄(29.9±13.8)岁;受伤至手术时间为(5.1±2.6)个月。采用经皮2枚空心加压螺钉置入进行内固定治疗,未进行植骨。记录并比较术前与末次随访时的疼痛视觉模拟评分(VAS)、握力(患侧与健侧百分比)、腕关节活动度、改良Mayo腕关节评分等数据,同时记录并发症发生情况。结果所有患者术后随访(20.8±8.9)个月随访。所有患者均未出现感染等并发症,均取得骨性愈合,骨折愈合时间为(10.1±3.2)周。术后影像学检查均未发现螺钉突出或脱出。末次随访时疼痛VAS评分为0(0,1)分,腕关节握力为100.6%±7.2%,腕关节屈曲活动度为88.3°±2.5°,腕关节背伸活动度为88.5°±2.2°,改良Mayo腕关节评分为(98.3±2.5)分,均较术前[4(4,5)分、69.1%±16.0%、61.3°±13.5°、64.7°±9.1°、(61.7±10.1)分]显著改善,差异均有统计学意义(P<0.05)。结论双螺钉经皮内固定治疗腕舟骨骨折不愈合或延迟愈合,创伤小,骨折愈合快,功能恢复好,且并非必须植骨。ObjectiveTo investigate the clinical efficacy of minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture.MethodsA retrospective study was conducted to analyze the 12 patients with delayed union or nonunion of scaphoid fracture who had been treated at Department of Hand and Foot Surgery,The Affiliated Hospital of Jining Medical University from March 2021 to December 2023.They were 11 males and 1 female,with an age of(29.9±13.8)years and an interval from injury to surgery of(5.1±2.6)months.They were all treated by minimally invasive percutaneous internal fixation with 2 hollow compression screws.The visual analogue scale(VAS),grip strength(percentage of the affected side to the healthy side),wrist range of motion,modified Mayo wrist score and other data were recorded and compared between pre-surgery and the last follow-up.The incidence of complications was recorded.ResultsFollow-up for all patients lasted for(20.8±8.9)months.All patients achieved bony union after(10.1±3.2)weeks with no complications like infection.No post-surgery imaging revealed screw misplacement or penetration.At the last follow-up,the VAS pain score was 0(0,1)point,the wrist grip strength 100.6%±7.2%,the wrist flexion 88.3°±2.5°,the wrist dorsiflexion 88.5°±2.2°,and the modified Mayo wrist score(98.3±2.5)points,all significantly better than the pre-surgery values[4(4,5)points,69.1%±16.0%,61.3°±13.5°,64.7°±9.1°,and(61.7±10.1)points](all P<0.05).ConclusionIn the treatment of delayed union or nonunion of scaphoid fracture,minimally invasive percutaneous internal fixation with double screws shows advantages of minimal invasion,quick fracture healing,fine functional recovery,and no need of bone grafting.

关 键 词：舟骨 骨折 不愈合 骨折固定术 内 骨螺丝 

分 类 号：R68[医药卫生—骨科学]