手术治疗舟骨骨折49例结果及体会

The results and experiences of the open reduction and internal fixation of 49 scaphoid fractures

目的报道手术治疗49例舟骨骨折的结果及体会。方法经皮或切开复位Acutrak钉/空心钉/可吸收钉/U形钉内固定舟骨骨折,陈旧性骨折及骨坏死者加做带血管蒂桡骨茎突骨瓣移植,记录术后骨折愈合时间、握力、腕关节活动度、疼痛、恢复工作时间及腕关节功能评分。结果对本组患者进行随访1～8.5年,平均3.6年;骨折愈合时间为7～12周,平均10.8周。腕关节平均评分85.2分;功能优28例,良21例,差0例。所有患者均恢复原来的工作或改为较轻的工作。结论经皮或切开复位螺钉固定、带血管蒂桡骨茎突骨瓣移植是治疗舟骨骨折的一种好方法;骨折类型不同,手术方法也需有所变化。Acutrak钉固定效果好于空心钉或可吸收钉。短期随访,未见有桡骨茎突切除的并发症。桡腕关节桡侧切口有利于显露骨折端及骨瓣制备,值得推荐。带血管蒂桡骨茎突骨瓣移植可缩短骨折愈合时间。

Objective The purpose of this study was to evaluate the surgical treatment outcome and experience of 49 patients with scaphoid fracture. Methods The benefits of using percutaneous Acutrak screw fixation in the stable scaphoid fractures and open reduction and fixation in Acutrack screw/ cannulated screw/can absorb screw/ ＂u＂ shaped nail were explored. The obsolete scaphoid fractures or avascular necrosis of the scaphoid were treated with grafts of vascular pedicle bone flap. The time of bone healing, grip strength rang of motion of the wrist, pain and the time of return to work were recorded. The results were evaluated according to Krimmer wrist score. Results The period of follow-up was 1 to 8.5 year （mean 3.6 year）. The time of bone healing was 7~12 week （mean 10.8 week）. The average Krimmer wrist score was 85.2 points, 28 of 49 patients were graded excellent, 21 good and 0 fair. All of the patients returned to original work or changed to a light one. Conclusions The percutaneous Acutrak screw fixation in the stable scaphoid fractures or open reduction and fixation in Acutrack screw and grafts of vascular pedicle bone flap in the obsolete scaphoid fractures or avascular necrosis of the scaphoid in a satisfactory way. Different type of the fracture should choose different procedure. With use of Acutrack screw, rigid internal fixation can be achieved and better than cannulated screw or an absorbable one. In the short follow-up there is no complication after the excision of the radial styloid. The incision of radial side is easy to reveal and make a bone flap. Using grafts of vascular pedicle bone flap can shorten the time of bone healing.