加压螺钉治疗舟骨骨折的临床疗效

Compression screw fixation of unstable scaphoid fractures

目的 评价加压螺钉内固定治疗舟骨骨折的临床疗效。方法 对 46例 (4 7侧 )舟骨骨折采用切开复位加压螺钉内固定治疗的患者 ,术后进行随访。从术后疼痛程度、腕关节活动度、手部握力、影像学检查、Krimmer腕关节评分和DASH(DisabilityofArm Shoulder Hand)问卷调查表等进行随访和疗效评估。结果 术后腕关节疼痛程度静息时为 2 ,用力时为 13。腕关节屈伸活动度 12 4°(达健侧 92 % ) ,尺桡偏5 7°(达健侧 91% ) ,平均握力 47kg(达健侧 90 % )。X线片及CT检查 :6例螺钉穿透骨皮质 ,4例发生腕关节炎 ,1例舟骨骨折不愈合及 1例畸形愈合。Krimmer评分总体疗效 :优 3 9侧 ,良 5侧 ,满意 3侧。DASH值为8 3。DASH问卷调查表结果显示 ,术后腕关节功能良好 ,仅有轻微不适症状。结论 应用切开复位加压螺钉内固定治疗舟骨骨折手术操作简便、疗效可靠。

ObjectiveThe purpose of this study was to evaluate the results after treatment of acute scaphoid fractures by internal screw fixation.MethodsFrom June 1995 to December 2000, 68 patients with acute scaphoid fractures were treated with open reduction and screw fixation. 46 patients with 47 fractures had sufficient follow up,the mean follow up time being 35 months. The parameters examined included pain, range of motion of the wrist, grip strength, and radiologic assessment of bone healing. The results were evaluated according to Krimmer wrist score. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess subjective functional outcomes after the surgery.ResultsThe average pain score was 2 (non stress) and 13 (stress). The average grip strength was 47 kg and 90% of the normal side. Range of motion of the wrist averaged 124° for extension/flexion and 57° for radial/ulnar deviation, being 92% and 91% of the opposite wrist, respectively. 46 of 47 scaphoid fractures united. Plain wrist X ray and computer tomography revealed penetration of the cortex by screws in 6 cases, mal union in 1 case, non union in 1 case, and osteoarthritis in 4 cases. According to the Krimmer wrist score, 39 cases were graded excellent, 5 good and 3 fair. The average DASH score was 8 3 points. The DASH questionnaire results showed that the postoperative functions were excellent and symptoms were minor.ConclusionOur results show that open reduction and internal screw fixation is an effective method for treatment of acute scaphoid fractures.