腕关节镜下植骨内固定治疗陈旧性舟骨骨折

Arthroscopic bone grafting with screw internal fixation for treatment of old scaphoid fractures

目的探讨腕关节镜辅助下植骨并空心加压螺钉内固定治疗陈旧性舟骨骨折的手术方法及临床疗效。方法自2013年9月至2015年5月，我们对9例陈旧性舟骨骨折的患者在腕关节镜辅助下，去除硬化骨、自体髂骨移植并以空心加压螺钉固定治疗。陈旧性舟骨骨折按Slade和Dodds分级：Ⅱ级4例，Ⅲ级4例，Ⅳ级1例。术后行固定及康复锻炼，定期拍摄X线片观察骨折愈合情况。采用改良Mayo腕关节评分系统评估患者腕关节功能。结果术后9例患者均获得随访，时间为5—12个月，平均8．5个月。所有骨折均愈合，平均愈合时间为12．6周。腕关节功能采用改良Mayo腕关节评分系统评估：优6例，良2例，可1例。结论在掌握适应证的前提下，在腕关节镜下去除硬化骨、自体骨植入及空心加压螺钉固定治疗陈旧性舟骨骨折，有其优势，能获得较满意的治疗效果。

Objective To analyze the preliminary clinical results of treating chronic scaphoid fracture with arthroscopic assisted internal fixation and autologous bone grafting. Methods From September 2013 to May 2015, a consecutive series of 9 patients with chronic scaphoid fractures were treated with arthroscopic assisted debridement of the sclerotic bone, pereutaneous screw internal fixation and autologous bone grafting. Based on Slade grading system, 4 cases were classified as grade Ⅱ , 4 as grade Ⅲ , and 1 as grade Ⅳ chronic scaphoid fractures. Postoperative evaluations included clinical and radiographic assessment, and wrist function assessment using modified Mayo wrist score. Results All 9 cases were follow-up for 5 to 12 months with an average of 8.5 months. All the fractures healed with an average bone union time of 12.6 weeks. The result was excellent in 6 cases, good in 2 cases and fair in 1 case according to the modified Mayo wrist score. Conclusion When properly indicated, arthroscopic assisted debridement of sclerotic bone, percutaneous screw internal fxation along with autologous bone graft is a reliable and minimally invasive method to treat chronic scaphoid fractures.