经皮微创Herbert螺钉内固定治疗腕舟骨骨折的临床研究

Clinical study of percutaneous minimally invasive Herbert screw internal fixation of scaphoid fracture

目的对比研究经皮微创Herbert螺钉内固定与石膏外固定治疗新鲜闭合腕舟骨腰部骨折的临床效果。方法将36例新鲜闭合性腕舟骨腰部骨折患者，随机分成Herbert螺钉组（n=18）和石膏组（n=18），术后或石膏固定后每个月腕关节拍X线片1次，2个月后每2周拍X线片1次，直至骨折愈合。对骨折愈合时间、重返工作岗位时间和腕关节活动度进行对比性研究。结果随访9～18个月，平均13．5个月。螺钉组18例（100．0％）全部骨性愈合，愈合时间为（15．20±2．94）周；石膏组18例中，15例（83．3％）骨性愈合，愈合时间为（20．30±3．72）周（P〈0．05）°重返工作岗位时间：螺钉组为（16．30±2．86）周；石膏组为（25．20±7．85）周（P〈0．05）。腕关节活动范围：螺钉组为（101．80±5．57）°；石膏组为（91．50±5．88）。（P〈0．05）。结论经皮微创Herbert螺钉内固定术治疗新鲜闭合性腕舟骨腰部骨折创伤小、操作简单、骨折愈合快、腕关节功能好、患者更早重返工作岗位，疗效明显优于石膏外固定。

Objective To comparison study the clinical effect of minimally invasive percutaneous Herbert internal fixa- tion and plaster external fixation for the treatment of fresh closed fracture of scaphoid waist. Methods 36 cases of fresh closed scaphoid waist fracture patients were randomly divided into Herbert screw group （n=18） and gypsum group （n= 18）,after surgery or plaster fixation,the wrist X-ray was given once a month for two months,and then every two weeks for an X-ray until the fracture healed.The fracture healing time,return to work time and wrist activity were comparative studied. Results During the follow-up of 9-18 months,average 13.5 months,18 cases in screw group were all healed （100.0%）,healing time was （15.20±2.94） weeks;In 18 cases of gypsum group,15 cases were healed （83.3%）,healing time was （20.30±3.72） weeks （P〈0.05）.Back to work time：screw group was （16.30±2.86） weeks;Gypsum group was （25.20± 7.85） weeks （P〈0.05）.Range of motion of the wrist joint：screw group was （101.80±5.57）°;Gypsum group was （91.50± 5.88）° （P〈0.05）. Conclusion The curative effect of minimally invasive percutaneous Herbert screw internal fixation is obviously better than plaster external fixation in the treatment of fresh closed fracture of scaphoid waist as its small trauma, simple operation,fast fracture healing,good wrist function and earlier return to work.