不稳定性腕舟骨腰部骨折不愈合的治疗

Treatment of unstable scaphoid waist fracture nonunion

目的 评估应用掌侧楔形植骨克氏针内固定治疗不稳定性腕舟骨腰部骨折不愈合的效果.方法 治疗12例成年男性患者,平均年龄为32.5岁,术前平均病程15.7个月.均为不稳定性腕舟骨腰部骨折不愈合伴驼背畸形,采用切开复位矫正塌陷畸形,掌侧楔形植骨克氏针内固定术.结果 术后随访9 ～ 23个月（平均12.5个月）,骨折均获得影像学愈合,平均3.6个月达到愈合.大多数患者的腕舟骨畸形以及腕背侧不稳（DISI）都得到满意的纠正.手术后腕关节的屈伸范围、握力以及腕背侧不稳的程度都得到改善.结论 应用掌侧楔形植骨克氏针内固定治疗不稳定性腕舟骨腰部骨折不愈合是有效的.

Objective To evaluate the results of treating unstable scaphoid waist fracture nonunion by anterior wedge bone graft and internal fixation with Kirschner wires.Methods Twelve adult male patients with unstable scaphoid waist fracture nonunion with a humpback deformity were treated by reduction of the collapse deformity,insertion of anterior wedge bone graft,and internal fixation with Kirschner wires.The mean patient age was 32.5 years,and the mean duration of the nonunion before surgery was 15.7 months.Results The follow-up time ranged from 9 to 23 months （mean,12.5 months）.Radiographic bone union was seen in all cases.Union was achieved in a mean of 3.6 months.Most of the patients had satisfactory correction of scaphoid deformity and the associated dorsal intercalated segment instability.Postoperatively,improvements were seen in the range of wrist flexion and extension,grip strength,and degree of dorsal intercalated segment instability.Conclusion The results of this series suggest that anterior wedge bone graft and internal fixation with Kirschner wires is an effective method for the treatment of unstable scaphoid waist fractures nonunion.