C型臂下微创经皮交叉克氏针治疗手舟骨骨折临床研究

Clinical study of minimally invasive percutaneous crossover K-wire fixation of scaphoid fractures under C-arm

目的 观察C型臂下微创经皮交叉克氏针治疗手舟骨骨折的临床疗效.方法 对2011年3月-2014年5月内蒙古医科大学附属医院骨科诊治的手舟骨新鲜骨折20例术后定期门诊随访,随访评估指标：Cooney腕关节评分系统、摄X线片观察骨折愈合情况、末次随访时患者的主观满意度问卷调查.结果 所有患者均获得随访,随访时间4～18个月,平均10个月.复查X线片示骨折均获得骨性愈合,愈合时间为8～12周,平均9.2周.末次随访时患者的主观满意度问卷调查显示：2例对治疗效果感觉一般,2例比较满意,余下16例患者非常满意.术后Cooney腕关节评分：优8例,良10例,可2例,Cooney腕关节评分中优良率可达90.2％.无针道感染、骨折不愈合、畸形愈合、手舟骨缺血性坏死等并发症.2例表现为腕关节负重活动及天气变凉时有疼痛,腕关节功能、活动度轻度受限,握力较对侧略差.结论 C型臂下微创经皮交叉克氏针加上术后适当运用石膏外固定治疗手舟骨骨折临床疗效好,值得推广.

Objective To observe the clinical efficacy of minimally invasive percutaneous K-wire crossover fixation treating scaphoid fractures under C-arm.Methods From March 2011 to May 2014,20 patients with fresh scaphoid fractures had postoperative regular outpatient follow-up.Evaluation indicators included Cooney wrist scoring system,X-ray assessment of fracture healing,questionnaire survey of patient＇s subjective satisfaction at the final follow-up.Results All patients were followed up for 4 to 18 months,the mean follow-up time being 10 months.Postoperative X-ray showed all cases achieved bony union within 8 to 12 weeks,an average of 9.2 weeks.The questionaire resuits of patient＇s subjective satisfaction showed that general feeling of treatment in 2 cases,relatively satisfied in 2 cases,greatly satisfied in remaining 16 patients at the final follow-up.According to the postoperative Cooney wrist score,excellent in 8 cases,good in 10 cases,fair in 2 cases,the overall satisfactory rate was 90.2%.There were not pin tract infection,nonunion,malunion,avascular necrosis of scaphoid and other complications.2 cases showed that wrist pain during weight-bearing activities and weather getting cold,minor limitations of wrist function and degree of activity,grip strength slightly worse than the contralateral.Conclusions Minimally invasive percutaneous K-wire crossover fixation under C-arm combined with postoperative plaster external fixation properly can attain good clinical results in the treating of scaphoid fractures and worthy of further promotion.