经皮经大多角骨入路逆行空心钉固定治疗急性稳定性舟骨腰部骨折

PERCUTANEOUS RETROGRADE CANNULATED SCREW FIXATION OF ACUTE STABLE SCAPHOID WAIST FRACTURE BY A TRANSTRAPEZIAL APPROACH

目的探讨经皮经大多角骨入路逆行空心钉固定治疗急性稳定性舟骨腰部骨折的方法及疗效。方法 2010年5月-2012年4月,收治23例急性稳定性舟骨腰部骨折患者。其中男18例,女5例;年龄21～54岁,平均32岁。骨折均为摔倒后手撑地所致。左侧10例,右侧13例。临床表现为腕关节桡侧肿胀,鼻烟窝压痛,握拳无力。2例合并同侧桡骨远端骨折。受伤至手术时间1～5 d,平均3 d。采用经皮经大多角骨入路逆行打入导针,选择合适长度空心钉固定舟骨骨折。结果术后患者切口均Ⅰ期愈合。23例均获随访,随访时间4～26个月,平均10个月。X线片示骨折均达骨性愈合,愈合时间6～12周,平均8.2周。患者均于术后4～6周恢复正常生活,2～4个月恢复原工作。末次随访时,腕关节无疼痛及局部压痛,握力30～51 kg,平均37 kg。腕关节屈伸总活动度为140～165°,平均153.7°。患者均对治疗效果满意。结论经皮经大多角骨入路逆行空心钉固定治疗急性稳定性舟骨腰部骨折是一种操作简便、安全、可靠的治疗方法,其更易将空心钉植于舟骨的长轴中央。

Objective To explore the technique and effectiveness of percutaneous retrograde cannulated screw fixation for acute stable scaphoid waist fracture by a transtrapezial approach. Methods Between May 2010 and April 2012, 23 patients with acute stable scaphoid waist fracture were treated with percutaneous retrograde cannulated screw fixation by a transtrapezial approach. There were 18 males and 5 females, aged 21-54 years with an average of 32 years. All fractures were caused by supporting with hands after falling. The locations were the left side in 10 cases and the right side in 13 cases. The major symptoms included the wrist swelling, tenderness at the anatomic snuffbox, and grip weakness. Two cases were accompanied by distal radius fractures. The time between injury and operation ranged from 1 to 5 days with an average of 3 days. Results All incisions healed by first intention. All the cases were followed up 4-26 months with an average of 10 months. All fractures healed 6-12 weeks postoperatively with an average of 8.2 weeks. The patients resumed normal life and work at 4-6 weeks and at 2-4 months after operation, respectively. At last follow-up, all the wrists were free from the pain and the tenderness. The postoperative grip power ranged from 30 to 51 kg （mean, 37 kg）. The active flexion-extension range of motion was 140-165° with an average of 153.7°. All patients were satisfied with the results of treatment. Conclusion Percutaneous retrograde cannulated screw fixation by a transtrapezial approach is a simple, safe, and reliable method to treat acute stable scaphoid waist fracture. By this approach, it is easier to place the screws into the center of the long axis of scaphoid.