应用掌侧小切口空心钉技术治疗新鲜舟骨骨折

Acute scaphoid fractures treated by cannulated compression screw fixation through a limited palmar approach

目的探讨应用掌侧小切口空心钉技术治疗新鲜舟骨骨折的疗效。方法2003年1月至2007年12月期间采用小切口空心钉技术治疗16例新鲜舟骨骨折，骨折按Herbea分型：A2型11例，B2型5例，其中2例合并桡骨远端骨折。术中以舟骨结节为中心，在腕关节掌桡侧做2cm长小切口，切除大多角骨基底掌侧关节面后，在导针引导、C型臂监视下于舟骨轴线上打入AO空心加压螺钉，术后不需外固定。结果16例中12例获得完整随访，时间6—55个月，平均18个月。骨折平均愈合时间42d，恢复工作时问平均10d（3-28d）。10例活动度与健侧相同，2例桡偏和掌屈欠5°。10例无疼痛等不适感觉，2例腕关节掌屈时感轻度疼痛，无其他严重并发症。结论掌侧小切口空心钉固定舟骨腰部骨折具有方法简单、创伤小、不需外固定、愈合率高等优点，治疗结果满意。

Objective To discuss the indication, surgical techniques, and results of cannulated compression screw fixation through a limited palmar approach for treatment of acute scaphoid fractures. Methods From 2003 to 2007, 16 patients with acute scaphoid fracture were treated by the above technique. All the fractures belonged to the Herbert A2 and Herbert B2 types, two of which were complicated with distal radial fracture. A longitudinal skin incision, approximately 2cm in length, was made at the palmer-radial side of the wrist, with the scaphoid tubercle located in the middle of the incision. After removal of palmar articular surface of the trapezium base, an appropriate length of AO cannulated compression screw was driven into the scaphoid along its axis under supervision of a mini C-arm image intensifier and direction of a guide wire. Immobilization was unnecessary after operation. Results We were able to follow up only 12 cases of them. The mean follow up was 18 （6 to 55） months. The mean radiological time of bone union was 42 days after operation. The mean time of resuming work was 10 （3 to 28） days. Ten of them obtained the same range of wrist motion as the contralateral side. Two patients lost an average radial deviation and palmar flexion of 5°. All patients experienced no pain except two who reported only mild pain at palmar flexion. No early complication was encountered. Conclusion Cannulated compression screw fixation through a limited palmar approach is fine for acute scaphoid fractures, because it is easy, leads to minimal lesion to soft tissue, allows immediate mobilization without prolonged casting, and promises a high union rate.