经皮无头加压空心螺钉结合外固定架治疗桡骨远端合并腕舟状骨骨折

Ipsilateral fractures of distal radius and scaphoid bone treated with percutaneous headless compression screws plus external fixation

【目的】探讨经皮无头加压空心螺钉结合外固定架治疗桡骨远端骨折合并腕舟状骨骨折的方法及疗效。【方法】28例新鲜桡骨远端骨折合并腕舟状骨骨折患者,根据桡骨远端骨折合并腕舟状骨骨折的移位程度按照AO分型,桡骨远端骨折均采用外固定架固定,复位方法有闭合手法复位,和/或克氏针撬拨复位,和/或有限切开复位内固定。腕舟状骨骨折均采用闭合复位经皮无头加压空心螺钉内固定术治疗。术后对患肢腕关节放射学指标及关节功能进行评估。【结果】28例患者均随访,时间6~24个月,平均12.6个月。骨折均一期愈合,骨折愈合时间8~11周,平均9.3周。腕关节功能评定参考改良Mayo腕关节功能评分标准：优17例,良8例,可2例,差1例;优良率为89.2%。未发现骨折不愈合腕舟状骨缺血性坏死等并发症。术后6个月时患侧腕关节功能与健侧相比,背伸及尺偏范围小于健侧腕关节且差异具有统计学意义（P〈0.05）。摄片复查示,掌倾角小于健侧腕关节并具有统计学意义（P〈0.05）,桡骨高度及尺偏角与健侧对照无明显差异（P〉0.05）。【结论】桡骨远端骨折合并腕舟状骨骨折采用经皮无头加压空心钉固定舟状骨,外固定架固定桡骨远端,具有良好临床疗效,可作为此类骨折治疗的一个选择方案。

【Objective】To evaluate the therapeutic efficacy of ipsilateral fractures of distal radius and scaphoid bone by headless compression screws and external fixation.【Methods】Twenty-eight cases of ipsilateral fractures of distal radius and scaphoid bone Were chosen and differentiated by AO classification. Distal radius fracture was treated with external fixation. Its reduction methods were closed manipulative reduction, and / or Kirschner needle-poking reduction, and / or limited open reduction plus internal fixation. Scaphoid fracture was treated with closed reduction and percutaneous headless compression screws plus internal fixation. Radiology indexes and joint functions of the suffered limb were assessed after the operation.【Results】The 28 cases were followed up for 6~24 months and the average follow-up period was 12.6 months. All the fractures were primarily healed and the average bony union time was 9.3 w（range 8~11 w）. The wrist functions of the patients after the operation were assessed according to the improved Mayo score system： excellent in 17 cases, good in 8 cases, fair in 2cases and poor in 1 case; the excellence and good rate was 89.2%. No nonunion of fractures and necrosis of scaphoid bone were found. After6 months of the operation, back extension and ulnar deflection range of the suffering carpal joint were less than those of the healthy side. The difference was statistically significant（P〈0.05）. Radiographic review showed that palmar tilt angle was smaller than that of the normal wrist（P〈0.05）. There was no significant difference in the height of radius and ulnar deviation angle（P〈0.05）.【Conclusion】The therapeutic efficacy of ipsilateral fractures of distal radius and scaphoid bone by headless compression screws and external fixation is satisfactory. It can be chosen to treat this kind of fractures. complications after early removement external fixator and functional physical exercises.