经皮加压螺钉内固定术治疗腕舟骨腰部骨折的效果

Effect of percutaneous compression screw fixation in treatment of scaphoid lumbar fractures

目的探讨掌侧入路经皮加压螺钉内固定治疗军事训练致急性腕舟骨腰部骨折的效果。方法回顾性分析2017-09至2020-06武警贵州总队医院收治的15例急性腕舟骨腰部骨折患者,采用微创经皮掌侧入路螺钉内固定治疗,予注射器针头定位成功后置入导针,沿导针完成螺钉置入。术后石膏制动2周,分阶段功能锻炼。15例术后随访平均(18.13±8.68)个月,采用修订版Mayo腕关节功能评分系统评估疗效,疼痛视觉模拟评分评定患者疼痛情况,末次随访记录双腕关节屈伸、尺桡偏的关节活动度及握力。结果15例手术均顺利完成,术中出血(2.50±1.02)ml;手术时间(44.73±5.67)min;术中、术后均无并发症发生。术后骨折顺利愈合,平均愈合时间(10.33±2.29)周,Mayo腕关节功能评分优14例,良1例。疼痛视觉模拟评分0分12例,4分1例,1分2例。末次随访记录双腕屈伸、尺桡偏的关节活动度及握力进行对比,差异无统计学意义。结论经皮加压螺钉内固定术治疗急性腕舟骨腰部骨折,方法简单、有效,手术时间短,避免了长时间石膏制动产生的关节僵硬。

Objective To investigate the effect of palmar approach percutaneous compression screw fixation in the treatment of acute scaphoid lumbar fractures caused by military training.Methods Fifteen patients with acute scaphoid lumbar fractures who were treated with minimally invasive percutaneous volar screw internal fixation from September 2017 to June 2020 were retrospectively reviewed.After successful positioning of the syringe needle,the guide needle was inserted and the screw placement was completed along the guide needle.After plaster immobilization for 2 weeks,staged functional exercises were performed.Al the patients were followed up for an average of(18.13±8.68)months.The modified Mayo wrist function score system was used to evaluate the curative effect.The visual analogue scale(VAS)was used to evaluate the pain of patients.The range of motion(ROM)and grip strength of wrist flexion and extension,ulnar and radial deviation were recorded in the last follow-up.Results All the operations were successfully completed with an average intraoperative bleeding amount of(2.50±1.02)ml,an average operation time of(44.73±5.67)min and with no complications during and after operation.The postoperative fracture healed smoothly,with an average healing time of(10.33±2.29)weeks.According to Mayo wrist function scoring system,14 cases were excellent,and 1 case was good.VAS of pain was 0 in 12 cases,4 in 1 case,and 1 in 2 cases.At the last follow-up,the flexion and extension of the wrist joint,the active range of motion(ROM)of ulnar and radial deviation and the grip strength were compared(P>0.05),and the difference was not statistically significant.Conclusions Percutaneous compression screw fixation in the treatment of acute scaphoid lumbar fractures which can avoid joint stiffness caused by long-term plaster immobilization is simple and effective,and can also shorten the operation time.