经皮交叉克氏针固定、自体骨髓移植治疗HerbertⅠ型腕舟骨骨折的临床研究

Clinical study of percutaneous K-wire fixation and transplantation of autogenous bone marrow for treatment of Herbert typeⅠscaphoid fracture

目的观察经皮交叉克氏针固定、自体骨髓移植治疗HerbertⅠ型腕舟骨骨折的临床效果。方法随机选择36例新鲜无错位(HerbertⅠ型)腕舟骨骨折患者,采用经皮交叉克氏针固定,抽取自体红骨髓5ml,快速、加压注入舟状骨骨折部位,术后6周开始,每周拍摄计算机X线片(CR-X)1次,至骨折愈合,并记录骨折愈合及恢复工作时间。结果术后随访6周～4年,36例全部愈合,骨折愈合时间为7～12周,平均8．3周。35例腕关节活动度达到健侧腕关节活动标准,活动后无疼痛,均恢复了正常工作。1例腕关节伸屈活动术后较术前有明显改善,但仍未达健侧腕关节活动范围,且活动时疼痛。结论经皮交叉克氏针固定、自体骨髓移植治疗HerbertⅠ型腕舟骨骨折,较传统治疗方法,具有损伤小、操作简单、安全,最大限度地避免了医源性损伤,缩短了骨折愈合时间,提高了治愈率,是一种有效的治疗方法。

Objective To observe the clinical results of percutaneous K-wire fixation and autogenous bone marrow transplantation for Herbert type Ⅰ seaphoid fractures. Methods Thirty-six cases of fresh Herbert type Ⅰ seapboid fractures were treated by percutaneous K-wire fixation. Meanwhile 5ml autogenous bone marrow was injected to the fracture site. CR-X ray films were collected weekly from 6th week after the operation till healing of the fracture. The time for bone union and return to work was recorded. Results All cases were followed-up for 6 weeks to 4 years. Bone union was achieved in all eases. The duration of bone union ranged from 7 to 12 weeks, the average being 8.3 weeks. Range of motion was the same as that of the healthy side in 35 eases after rehabilitation. Those patients were pain flee and returned to original work. Wrist movement of Ⅰ case was impaired to some extent. There was also motion pain. Conclusion Pereutaneous K-wire fixation and autogenous bone marrow transplantation is a minimally invasive, simple, and safe method to treat Herbert type I scaphoid fractures. It avoids iatrngenie injuries, reduces healing time, and increases healing rate.