四角融合术治疗舟骨骨不连腕进行性塌陷

Four-corner fusion with locking mini titanium plate for scaphoid nonunion advanced collapse

[目的]介绍腕骨四角融合术微型锁定钛板内固定治疗舟骨骨不连腕进行性塌陷(scaphoid nonunion advanced collapse,SNAC)的手术技术和初步疗效。[方法] 2012年6月~2016年9月,5例SNAC患者接受手术治疗。术中彻底切除舟骨,显露月骨、头骨、三角骨及钩骨,保护月桡关节软骨,去除上述4块腕骨间关节软骨面至松质骨面,调整头骨及月骨对位关系,将自体骨粒充填至头骨、月骨、三角骨及钩骨之间,将微型钛板置入上述4块腕骨背侧,4枚螺钉固定。[结果]术后切口均I期愈合,均无骨不连、伤口感染、皮肤坏死等并发症。术后平均随访(26.81±2.28)个月,5例患者腕关节静息时疼痛均完全缓解,1例长时间重体力劳动偶有疼痛;所有患者握力均有明显好转;关节活动度达到健侧的50%以上。[结论]应用四角融合术微型锁定钛板内固定治疗SNAC安全有效,融合率高,能够明显缓解疼痛,保存部分腕关节功能。

[Objective]To introduce the surgical technique and primary clinical outcomes of four-corner fusion with locking micro-titanium plate for scaphoid nonunion advanced collapse(SNAG).[Methods]From June 2012 to September 2016,a total of 5 patients underwent four-corner fusion for SNAC.After the scaphoid was completely excised,the lunate,capitate,triangular and hamate were exposed.Keeping the radiolunatearticular cartilage intact,the articular surfaces among the 4 carpal bones were removed,and then granular bone autografts were filled into the spaces among the 4 bones.As adjusting the capitolunate to normal alignment,the 4 bones were fixed with a H-shaped locking mini titanium plate and 4 screws,one for each bone on the dorsal side.[Results]All the patients had operation performed smoothly and achieved primary incision healing without complications,such as incision infection and skin necrosis.During follow up of(26.81±2.28)months on average,the 5 patients got complete relief of pain at rest gradually,whereas one of them had occasional pain on heavy work in long time.In addition,the patients had significant improvement in grip strength and wrist range of motion,which reached over 50%of the healthy side.[Conclusion]This four-corner fusion is an effective and safe technique for scaphoid nonunion advanced collapse,and provide obvious pain relief with reliable fixation and high fusion rate.