空心螺钉不同置入方法治疗腕舟状骨骨折疗效比较

Comparison of two insertion methods of cannulated screw for treatment of scaphoid fracture

[目的]评价腕掌侧入路加压螺钉由腕舟状骨近极向远极固定和由远极向近极固定对腕舟状骨骨折患者骨折预后及功能恢复的临床疗效。[方法]采用腕掌侧入路加压螺钉治疗48例腕舟状骨骨折患者,均为跌伤,按手术方法不同分为两组,近极向远极组:由腕舟状骨近极向远极固定(23例),远极向近极组:由腕舟状骨远极向近极固定(25例)。随访并比较两组间骨折愈合时间、愈合率及腕关节功能Cooney评分和DASH问卷调查表结果。[结果]近极向远极组有20例获得骨性愈合,愈合率86.9%,平均愈合时间(10.52±2.85)周,远极向近极组有19例获得骨性愈合,愈合率76%,平均愈合时间(14.31±1.98)周,两组比较差异有统计学意义(P<0.05)。Cooney评分结果:近极向远极组:优11例,良7例,中1例,差1例,优良率78.26%;远极向近极组:优9例,良4例,中2例,差4例,优良率52%,两组比较差异有统计学意义(P<0.05)。DASH问卷调查表评分:近极向远极组平均值(7.32±1.28)分,低于远极向近极组的(9.58±3.24)分,差异有统计学意义(P<0.05)。[结论]腕掌侧入路加压螺钉采用由近极向远极固定的方法能够较好地保护腕舟状骨血供,比由远极向近极固定更有效地促进骨折愈合及术后腕关节功能的恢复。

[Objective] To evaluate and compare the outcome of seaphoid fracture treated with fixation of cannulated screws inserted from the proximal pole to the distal pole versus the distal to the proximal of scaphoid. [Methods] Forty-eight patients of wrist scaphoid fracture received surgical treatment and were divided into two groups according to screw placement methods, including 23 patients had the fracture fixed with cannulated screw from the proximal to the distal （the PD group）, while the remaining 25 patients got the screw inserted from the distal to the proximal （the DP group） . The bone healing time, bone healing rate, Cooney wrist joint function score and the DASH questionnaire results were compared between the two groups. [Results] In the PD group 20 patients （86.9%） got bony healing in an average of （10.5±2.85） weeks, whereas in the DP group only 19 patients （76%） obtained osseous healing in a mean of （14.3±1.98） weeks. There were statistically significant differences between two groups in both the healing rate and the healing time （P〈0. 05） . Depending on Cooney score, the results were graded excellent in 11 patients, good in 7, fair in 1 and poor in 1 in the PD group with the excellent and good results rate of 78.26%, while excellent in 9, good in 4, fair in 2 and poor in 4 in the DP group with corresponding rate of 52%, where there were statistically significant differences between the two groups （P〈0.05） . In addition, DASH questionnaire scores, （7.3±1.28） in the PD group and （9.5±3.24） in the DP group respectively, were significantly different as well （P〈0.05） . [Conclusion] A cannulated screw inserted from the proximal to the distal of the scaphoid through palmar approach might protect the blood supply more effectively than the reverse insertion technique, therefore achieves better outcome in fracture healing and function recovery of wrist joint after surgery.