双头空心加压螺钉治疗舟骨骨折术后功能恢复的相关因素分析

Open reduction and internal fixation of scaphoid fractures with double-headed cannulated compression screw： a linear correlation analysis of clinical and radiological outcomes

目的通过对临床和影像学结果进行直线相关性分析研究，探讨影响双头空心加压螺钉治疗舟骨骨折术后功能恢复的因素。方法2007年12月至2012年8月，应用3．0mmAO双头空心加压螺钉治疗舟骨骨折20例。男12例，女8例；年龄15～55岁，平均32．7岁。按照AO分型：B1型8例，B2型10例，C2型1例，C3型1例。随访内容包括腕关节功能客观指标：主动活动度（active range of motion, AROM）、前臂旋转活动度、握力、捏力；影像学指标：腕高比（carpal height ratio，CHR）、舟月骨间角（scapholunate angle，SLA）、螺钉与舟骨长轴之间的夹角、螺钉与骨折线之间的夹角。对随访数据进行直线相关性分析，比较腕关节功能客观指标与影像学指标之间的相关性。结果随访时间10～44个月，平均21．7个月。通过对腕关节功能客观指标和影像学指标进行直线相关性分析，发现在所测量值范围内握力和螺钉与舟骨长轴之间的夹角呈正相关关系（P=0．04，r=0．47）；旋后和舟月骨间角呈正相关关系（P=0．04，r=0．45）；前臂旋前和腕高比呈负相关关系（P=0．01，r=－0．54）。结论在本研究测量值范围内，握力和螺钉与舟骨长轴之间的夹角、旋后活动度和舟月骨间角呈正比；前臂旋前活动度和腕高比呈反比。结合研究结果，建议在临床应用双头空心加压螺钉治疗舟骨骨折时应尽量把螺钉放置在舟骨的居中位置，同时注意舟月骨间角、腕骨高度的恢复。

Objective To investigate factors that influence functional recovery after surgical treatment of scaphoid fractures with double-headed cannulated compression screw through linear correlation analysis of clinical and radiographic outcomes. Methods From December 2007 to August 2012, 20 scaphoid fractures were treated with open reduction and internal fixation with 3.0 mm AO carmulated compression screws. There were 12 males and 8 females. The average age was 32.7 years, ranging from 15 to 55 years. According to AO classification, there were 8 cases of type B1, 10 cases of type B2, 1 case of type C2 and 1 case of type C3 fractures. Postoperative follow-up evaluations included both objective wrist function indicators including active range of motion of wrist and forearm rotation, grip strength, pinch strength; and radiographic parameters including carpal height ratio （CHR）, scapholunate angle （SLA）, the angle between screw and the longitudinal axis of the scaphoid, and the angle between the screw and the fracture line. Correlation between the objective data and the radiographic parameters were analyzed. Results FoUow-up time ranged from 10 to 44 months, with an average of 21.7 months. There were positive correlations between grip strength and the angle between the screw and the longitudinal axis of the scapboid （ P = 0.04, r = 0. 47）, and between supination and SLA （ P = 0. 04, r =0. 45）. There was a negative correlation between pronation and CHR （ P = 0. 01, r = - 0.54）. Conclusion Within the scope of our measured values, grip strength and supination were positively proportionate to the angle between the screw and the longitudinal axis of the scaphoid and to SLA, respectively; while pronation was inversely proportionate to CHR. Based on our results we recommend placing the double-headed cannulated compression screw centrally in the scaphoid when fixing scaphoid fractures and paying attention to restoring SLA and CHR.