外固定支架结合空心螺钉克氏针内固定治疗舟骨骨折合并经舟骨月骨周围脱位

External fixator combined with cannulated screw and Kirschner wire fixation for the treatment of scaphoid fractures and transscaphoid perilunate dislocation

目的 总结外固定支架结合空心螺钉克氏针内固定治疗舟骨骨折合并经舟骨月骨周围脱位的临床疗效.方法 自2009年12月至2014年12月,我们共收治18例舟骨骨折合并经舟骨月骨周围脱位患者,其中9例行腕关节外固定支架固定,同时切开复位空心螺钉固定舟骨骨折,克氏针临时固定头月关节,并修复腕骨间韧带;另9例采用相同内固定术式,亦修复腕骨间韧带,术后采用石膏托外固定.结果 术后随访时间12- 24个月,所有患者均基本恢复腕关节功能,未出现再次脱位及舟骨月骨坏死.采用Cooney评分系统评定：外固定支架固定组优4例,良4例,可1例;石膏托外固定组优2例,良2例,可5例,差异有统计学意义（P＜0.05）.外固定支架固定组的腕关节屈伸活动度恢复明显优于石膏托固定组（P＜0.05）,而腕关节尺、桡偏活动度比较差异无统计学意义（P＞0.05）.结论 外固定支架固定在舟骨骨折合并经舟骨月骨周围脱位的治疗中发挥重要作用,有利于韧带早期修复及腕关节功能的早期恢复.

Objective To summarize the clinical outcomes of treating scaphoid fracture and transscaphoid perilunate dislocation using external fixator combined with cannulated screw and Kirschner wire fixation.Methods From December 2009 to December 2014,18 cases of scaphoid fracture and transscaphoid perilunate dislocation were treated.The external fixator was applied to immobilize the wrist in 9 cases,while the scaphoid fracture was reduced and fixed with a cannulated screw.The capitate lunate joint was fixed temporarily with a Kirschner wire and the intercarpal ligaments were repaired.The other 9 cases were treated with the same internal fixation technique and intercarpal ligament repair,while the wrist joint was immobilized with a plaster cast postoperatively.Results All the patients were follow-up for 12 to 24 months and achieved wrist function recovery.There was no re-dislocation or avascular necrosis of the scaphoid or lunate.The Cooney scoring revealed excellent results in 4 cases,good results in 4 cases and fair results in 1 case in the external fixator group.In the plaster cast group,the results were excellent in 2 cases,good in 2 cases and fair in 5 cases.The difference was statistically significant （P 〈 0.05）.Range of motion of wrist flexion and extension was significantly better in the external fixator group than in the plaster cast group （P 〈 0.05）,while ulnar and radial deviation were not different （P 〉 0.05）.Conclusion The external fixator plays an important role in the treatment of scaphoid fracture and transscaphoid perilunate dislocation,as it facilitates early ligament repair and wrist joint function recovery.