辅助性外固定支具在经皮内固定治疗手舟骨骨折术中的应用

Application of auxiliary external fixation brace during the procedure of percutaneous internal fixation of scaphoid fracture

目的 探讨辅助性外固定支具在经皮内固定治疗手舟骨骨折术中的应用效果.方法 2011年9月至2013年6月对18例手舟骨骨折患者,术前将低温热塑板依据腕部背伸、尺偏、拇指略外展体位形态塑形,适当修剪消毒后术中应用于经皮内固定治疗手舟骨骨折.术中记录调整克氏针的次数和透视次数.术后随访复查X线片,末次随访根据改良Mayo法对腕关节功能进行评估.结果 术中透视提示该支具材料不影响术中对舟骨的观察.每次透视时摆放体位所花费的时间明显缩短,且相同体位下透视重复率明显改善.术中一般需调整克氏针1～3次,透视次数为9～ 12次.手术时间约为10 ～ 30 min,平均20 min.术后随访时间为3～ 10个月,所有患者均骨性愈合,根据改良Mayo法评估腕关节功能：优9例,良7例,可2例.结论 辅助性外固定支具具备手术操作窗口,能临时固定腕关节,进一步简化手舟骨骨折手术操作,缩短手术时间,降低患者和术者X线暴露量,值得推广应用.

Objective To evaluate the value of applying auxiliary external fixation brace during the procedure of percutaneous internal fixation of scaphoid fractures.Methods Eighteen patients treated between September 2011 and June 2013 were involved.Preoperatively low-temperature thermoplastic material was shaped according to the patient＆#39;s wrist and hand profile with the wrist in dorsiflexion and ulnar deviation,and thumb in slight abduction.The molded brace was trimmed and sterilized.Intraoperatively the braced was used as an external fixator during the percutaneous internal fixation of seaphoid fractures.The number of times necessary to adjust the Kirschner wires and to use intraoperative fluoroscopy was recorded.Postoperative follow-up included wrist X-rays and modified Mayo wrist function assessment.Results Intraoperative fluoroscopy suggested that the brace did not affect fluoroscopy observation of the scaphoid.Time for limb placement was significantly shorter for each fluoroscopy observation,and the repetition rate of intraoperative fluoroscopy was significantly reduced.Kirschner wires typically required 1 to 3 times of adjustment.Intraoperative fluoroscopy observation ranged from 9 to 12 times.The operation time was about 10 to 30 minutes,with an average of about 20 minutes.After 3 to 10 months＆#39; follow-up all the fractures healed.According to Mayo criteria the wrist function was rated as excellent in 9 cases,good in 7 cases and fair in 2 cases.Conclusion Auxiliary external fixation brace with an operating window can temporarily hold the wrist in place during surgical treatment of scaphoid fractures.Its application simplifies surgical maneuvers,shortens the operation time,and reduces X-ray exposure of both the patient and the surgeon.This brace should be widely applied.