腕关节镜下经皮螺钉内固定术在腕舟骨骨折中的应用

Application of percutaneous screw internal fixation in wrist scaphoid fracture

目的观察腕关节镜下经皮螺钉固定术在腕舟骨骨折中的应用效果。方法回顾性分析2015年6月—2017年6月郑州市骨科医院手外一科收治的31例腕舟骨骨折患者临床资料,根据患者主观意愿选择治疗方式,分为腕关节镜组17例(采用腕关节镜下经皮螺钉内固定术),手法复位组14例(采用手法复位石膏外固定术)。比较分析两组患者在术后2周主观疼痛感受(VAS评分)、治疗后6个月复查时Mayo腕关节功能得分情况,对比患者骨折愈合时间与重返工作时间之间的差异,并在末次随诊时比较两组患者腕关节活动度。结果两组患者均骨折愈合,无延迟愈合以及不愈合等情况,愈合率100. 00%。在治疗后2周VAS患者评价主观疼痛感受,两组患者VAS评分均有明显降低(P <0. 05),治疗6个月后Mayo腕关节功能评分比较,腕关节镜组评分优良率94. 12%,手法复位组优良率75. 00%,Mayo腕关节功能评分各维度包括疼痛程度、工作情况、活动范围、握力以及总分腕关节镜组得分情况均要显著优于手法复位组(P <0. 05)。腕关节镜组骨折愈合时间以及返回工作时间均要短于手法复位组(P <0. 05)。患者在末次随诊时腕关节镜组患侧与健侧的腕关节活动度无明显差异(P> 0. 05),而手法复位组患侧腕关节活动度要低于其健侧腕关节的活动度(P <0. 05),腕关节镜组患侧腕关节活动度明显好于手法复位组(P <0. 05)。结论腕关节镜下经皮螺钉固定术在腕舟骨骨折中的应用效果较好,值得推广使用。

Objective To observe the effect of percutaneous arthroscopic screw fixation in the treatment of scaphoid fractures. Methods Clinical data of 31 patients with scaphoid fractures was retrospectively analyzed,who were admitted to the Department of Hand Surgery,Zhengzhou Orthopaedics Hospital from Jun. 2015 to Jun. 2017. According to the subjective willingness of patients,the treatment was divided into wrist arthroscopy group （17 cases） and manual reduction group （14 cases）. Patients in the wrist arthroscopy group were treated with percutaneous screw internal fixation and patients in the manual reduction group were treated with manual reduction of external fixation. The subjective pain perception （VAS score） at 2 weeks postoperatively,the Mayo wrist joint function score at 6 months after treatment,and the difference between the fracture healing time and the return-to-work time of the patient and wrist joint mobility at the last follow-up were compared and analyzed between the two groups. Results All the patients in both groups achieved bone healing,without delayed healing or non-healing. VAS was evaluated at 2 weeks after treatment and the VAS scores of the two groups were significantly decreased（ P 〈0.05）. The Mayo wrist joint function scores were compared after 6 months of treatment and the excellent rate of wrist arthroscopy group score was 94.12% in the arthroscopy group and 75.00% in the manual reduction group. The dimensions of the Mayo wrist function score including pain degree,working condition,range of motion,grip strength and total score of the wrist arthroscopy group were significantly better than those of the manual reduction group（ P 〈0.05）. The fracture healing time and return-to-work time of the wrist arthroscopy group were shorter than those of the manual reduction group（ P 〈0.05）. There was no significant difference in wrist mobility between the affected side and the healthy side of the wrist arthroscopy group at the last follow-up（ P 〉0.05）,while in the manual reduction group,the wrist joint activity was lower than that of the healthy wrist joint. The degree of activity was significantly higher in the wrist joint group than that in the manual reduction group（ P 〈0.05）. Conclusion The application of percutaneous transluminal screw fixation in the treatment of scaphoid fractures is good and worthy of promotion.