经掌桡侧入路Herbert螺钉治疗新鲜舟状骨腰部骨折早期临床疗效

Early clinical effect of palmar approach and Herbert screws in treatment of fresh scaphoid waist fracture

目的探讨经掌桡侧入路Herbert螺钉治疗新鲜舟状骨腰部骨折早期临床疗效。方法共收治32例新鲜舟状骨腰部骨折患者,年龄15.0～51.0岁,平均年龄(34.4±6.9)岁;左手12例,右手20例。致伤原因:车祸伤10例,重物压砸伤9例,摔伤11例,其他2例。均为闭合性新鲜骨折,受伤至手术时间为3～10 d,平均5 d,所有患者均采取经掌桡侧入路Her-bert螺钉内固定。结果 32例均获得随访,随访时间6.0～24.0个月,平均12.4个月。术后所有患者手术切口Ⅰ期愈合,骨折均愈合,无骨不连、感染、螺钉松动、断裂,舟状骨缺血性坏死等并发症。腕关节功能评定参考改良Mayo法评分标准:优18例,良11例,可3例,优良率为90.6%。结论经掌桡侧入路治疗新鲜舟状骨腰部骨折,入路方便,血管神经损伤的风险小,Herbert螺钉固定稳定牢靠,可作为治疗新鲜舟状骨腰部的有效方法之一。

Objective To investigate the early clinical effect of Herbert screws through the palmar-radial approach for the treatment of fresh scaphoid waist fracture. Methods Thirty-two patients with fresh seaphoid waist fracture were subjected to the internal fixation with Herbert screws through the palmar-radial approach, including 10 males and 11 females, 12 left hands and 20 right hands, aged from 15.0-51.0 years （mean 34.4± 6.9）. The injury reasons were as follows： traffic accident （10 cases）, bruise （9 cases）, falling injury （11 cases）, others （2 cases）. All patients were suffered from closed fresh frac- tures. The average time from the injury to operation was 5 days （3-10 days）. Results The mean follow-up duration was 12.4 months （6-24 months）. All the operational inaisions obtained one-stage healing, and the fractures were cured. All the cases had no complications such as bone disunion, infection, screw loosing and fragmentation, ischemic necrosis of scaphoid. Accord ing to the modified Mayo standard, the results were excellent in 18 cases, and good in 1leases, with the effective rate being 90.6%. Conclusion The internal fixation with Herbert screws through the palmar-radial approach for the treatment of fresh scaphoid waist fracture was an available technology with convenient approach, less injury for vascellum and nerve and fast fixa- tion with the Herbert screw, and can be used as an effective method for fresh seaphoid waist fracture.