双头加压螺钉治疗舟骨骨折的疗效分析

Curative effect of double-headed compression screw on scaphoid fracture

目的探讨双头加压螺钉治疗舟骨骨折的治疗效果。方法收集2011年1月至2013年12月收治并获得随访的舟骨骨折患者的病例资料，按照纳入及排除标准共46例患者纳入研究进行回顾性分析。46例中男31例，女15例；年龄17—73岁，平均37．2岁。根据骨折的粉碎情况及移位程度分别采用切开／闭合复位双头加压螺钉结合克氏针的方式进行固定，管型石膏辅助外固定6周，术后6周、3个月（骨折未愈合者增加4个月随访）、6个月、12个月进行随访，明确患者骨折愈合情况，有无并发症发生，术后1年应用Mayo腕功能评价标准对患侧腕关节功能进行评估。结果所有患者术后均获得随访，随访时间12～24个月，平均16．2个月。32例患者术后3个月内愈合。6例患者术后4个月内愈合，平均骨折愈合时间为3．1个月。术后1年患者腕关节功能均恢复至伤前水平。根据Mayo腕关节功能评分标准对术后1年时患者腕关节功能进行评估，优35例（76．1％）、良11例（23．9％），优良率为100％。结论双头加压螺钉治疗舟骨骨折时具有骨折断端有效加压、允许早期功能锻炼、获得良好腕关节功能、减少相关并发症等优点，是治疗舟骨骨折的有效方式。

Objective To investigate the curative effect of double-headed compression screw on scaphoid fracture. Methods Forty-six patients included in the study were analyzed retrospectively in accordance with inclusion and exclusion criteria, they were all operated from January 2011 to December 2013, and then followed up to obtain the medical records. There were 31 males and 15 females; aged 17 -73 years, 37.2 years in average. According to the situation of the comminuted fracture and the degree of displacement, they were fixed respectively by open/closed reduction and double compression screw combined with kirschner pin, external fixation with plaster casts auxiliary for 6 weeks. Follow-up on the 6 weeks, 3 months （unhealed fracture patients increase 4 month follow up）, 6 months and 12 months after surgery, clear the situation of fracture healing and whether there were complications. While the application of Mayo wrist functional evaluation criteria in 1 year after surgery to assess the affected wrist function. Results All patients were followed up for 12 to 24 months, with an average follow up time was 16. 2 months. Within 3 months after surgery, 32 patients with fracture healing, within 4 months after surgery, 6 patients with fracture healing, the average healing time was 3. 1 months. Wrist function was re stored to pre-injury level at 1 year after surgery. To assess the wrist function with Mayo wrist functional evaluation criteria at 1 year after surgery, excellent in 35 eases（76. 1% ）, good in 11 cases（23.9% ）, the excellent and good rate was 100%. Conclusions The fixation with double-headed compression screw is a reliable method for the treatment of scaphoid fracture, with the characteristics of effective pressure on the fracture site, allowing earlier exercise, better wrist function, less complication, and so on.