腕舟状骨骨折微创手术治疗

Minimally invasive surgery for scaphoid fractures

目的探讨腕舟状骨骨折微创手术治疗的临床疗效。方法在C臂机透视下，采用掌侧或背侧入路经皮或小切口导针指引置入AO空心加压螺钉或Herbert钉治疗舟状骨骨折患者19例，根据Herbert分型：A2型2例，B1型3例，R2型9例，B3型4例，C型1例。经掌侧入路9例，背侧入路10例。结果术后随访6～18个月，所有病例骨折均愈合，愈合时间6～12周，平均9．5周。腕关节功能采用改良Mayo评分：优6例，良11例，可2例。腕关节平均活动度为伸腕68°（550～850）、屈腕57°（45°-85°），患者均恢复工作，2例在重体力活动中有轻度腕关节疼痛，其中1例因螺钉头穿出舟骨远极皮质约2mm，腕关节极度桡偏活动时可诱发疼痛。结论AO空心加压螺钉或Herbert钉微创治疗舟状骨骨折固定牢靠，疗效确切。

Objective To evaluate the clinical outcomes of minimally invasive operation for the treatment of seaphoid fractures. Methods Under C ann fluoroscopy, 19 cases of seaphoid fractures were treated with AO compressed hollow screws or Herbert screws introduced through a pereutaneous or small incision guide via the volar or dorsal approach. According to Herbert＇s classification, there were 2 eases of type A2 fractures,3 cases of type B1, 9 eases of type B2, 4 eases of type B3, and 1 case of type C fracture. Volar approach was used in 9 cases, while dorsal approach in l0 cases. Results All the cases were follow-up for 6 to 18 months postoperatively. All the fractures healed. The time of fracture healing was 6 to 12 weeks, with an average of 9.5 weeks. Based on the mtMified Mayo scoring system, the wrist function was rated as excellent in 6 cases, good in 11 cases, and fair in 2 cases. The mean extension of the wrist was 68° （range, 55° to 85°）, while the mean flexion of the wrist was 57° （range, 45° to 75°）. All patients had returned to work, with only mild wrist pain in 2 eases during heavy physical activities. In 1 ease where the screw head was 2 nun out of the scaphoid far pole cortex, pain could be evoked during extreme radial deviation of the wrist. Conclusion AO compressed hollow screws or Herbert screws can achieve minimally invasivc fixation of seaphoid fractures with reliable fixation and satisfactory results.