镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围脱位

Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation

目的评估镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围脱位的临床疗效。方法 2011年9月-2018年10月,采用镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围背侧脱位型患者17例。男12例,女5例;年龄23~52岁,平均32.6岁。病程8 h^9 d,平均6.5 d。致伤原因:摔伤6例,交通事故伤4例,运动致腕部应力性损伤3例,机器撞击致腕部暴力性损伤2例,军事训练致伤1例,其他伤1例。合并神经损伤1例。根据Herbert分型均为B4型。术前1周及术后3、6个月和末次随访时根据Krimmer评分表评价腕关节功能。结果 17例患者术后均获随访,随访时间10.5~48个月,平均18.6个月。术后无内固定物松动、感染以及舟、月骨坏死发生。患者月骨周围脱位均复位良好,舟骨骨折均愈合,愈合时间为4~18个月,平均11.3个月。术前1周,术后3、6个月及末次随访时Krimmer腕关节评分分别为(37.5±4.4)、(61.3±7.2)、(83.3±9.3)、(87.3±8.2)分。术后各时间点Krimmer腕关节评分均较术前显著改善,术后6个月及末次随访时较术后3个月显著改善,差异均有统计学意义(P<0.05);术后6个月及末次随访间差异无统计学意义(P>0.05)。末次随访时Krimmer腕关节功能获优13例、良2例、可1例、差1例、优良率88.23%。结论镍钛记忆合金两脚固定器联合克氏针治疗经舟骨月骨周围脱位疗效确切,手术操作简便,术后腕关节功能恢复良好。

Objective To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.Methods Between September 2011 and October 2018,17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire.There were 12 males and 5 females,with an average age of 32.6 years(range,23-52 years).The disease duration was 8 hours to 9 days,with an average of 6.5 days.The causes of injury included 6 cases of falling injury,4 cases of traffic accident injury,3 cases of stress injury of wrist caused by sports,2 cases of violent injury of wrist caused by machine impact,1 case of military training injury,and 1 case of other injury.One case was complicated with nerve injury.According to Herbert’s classification,all the fractures were type B4.At 1 week before operation,3 months,6 months after operation and last follow-up,the wrist function was evaluated according to the Krimmer scale score.Results All the 17 patients were followed up 10.5-48 months,with an average of 18.6 months.There was no loosening or infection of the internal fixator,no necrosis of the scaphoid and lunate.The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed.The healing time was 4-18 months,with an average of 11.3 months.The Krimmer wrist scores were 37.5±4.4,61.3±7.2,83.3±9.3,87.3±8.2 at 1 week before operation,3 months,6 months after operation and last follow-up,respectively.The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation(P<0.05),and at 6 months after operation and last follow-up than at 3 months after operation(P<0.05).There was no significant difference between at 6 months and last follow-up(P>0.05).At last follow-up,the Krimmer wrist function was excellent in 13 cases,good in 2 cases,fair in 1 case,poor in 1 case,and the excellent and good rate was 88.23%.Conclusion Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness,simple operation,and good recovery of wrist function after operation.