腕关节镜辅助经皮螺钉内固定腕舟骨骨折

Wrist arthroscopy assisted percutaneous screw fixation of scaphoid fractures

[目的]探讨腕关节镜辅助经皮螺钉内固定治疗腕舟骨骨折的临床效果。[方法]2014年2月~2017年12月收治的86例腕舟骨骨折患者,采用随机数字表法分为两组,每组43例。经皮组采用透视下闭合复位经皮螺钉内固定治疗,关节镜组采用腕关节镜辅助经皮螺钉内固定治疗。比较两组手术指标、Cooney腕关节评分和影像资料。[结果]两组患者均顺利完成手术,术中无血管、神经损伤。经皮组手术时间、切口总长度显著小于关节镜组(P<0.05),但前者术中透视次数显著多于后者(P<0.05)。关节镜组术后开始主动活动时间、完全负重活动时间少于经皮组(P<0.05)。末次随访时两组患者Cooney评分的疼痛、功能、活动范围和总分均较术前显著增加(P<0.05)。术前两组间Cooney评分各亚项和总分的差异均无统计学意义(P>0.05);末次随访时,关节镜组Cooney评分的疼痛、功能、活动范围和总分均显著高于经皮组,差异均有统计学意义(P<0.05)。影像方面,关节镜组术后3个月骨痂量评分和骨折愈合时间均显著优于经皮组(P<0.05)。[结论]腕关节镜辅助可有效提升经皮螺钉内固定腕舟骨骨折的临床效果。

[Objective]To evaluate the clinical outcomes of wrist arthroscopy assisted percutaneous screw fixation in treatment of scaphoid fracture.[Methods]From February 2014 to December 2017,86 patients with scaphoid fracture were divided into two groups by random number table method,with 43 patients in each group.The patients in the percutaneous group received closed reduction and percutaneous screw fixation under fluoroscopy,while those in the arthroscopic group underwent reduction and screw fixation under assistance of wrist arthroscopy.The clinical documents,Cooney wrist joint score and radiographic data were compared between the two groups.[Results]All the patients in both groups had operation finished smoothly without injuries to blood vessel and nerve.Although the percutaneous group was significantly superior to the arthroscopic group in operation time and total incision length(P<0.05),the former was inferior to the latter in intraoperative fluoroscopic frequency.The Cooney score,including sub scores of pain,function,range of motion,and the total score significantly increased in both groups at the latest follow-up compared with those before operation(P<0.05).Although there was no statistically significant differences in the sub scores and total score between the two groups before operation(P>0.05),the arthroscopic group proved significantly superior to the percutaneous group in Cooney score at the latest follow up(P<0.05).In term of radiographic assessment,the arthroscopic group also was significantly superior to the percutaneous group regarding the score of bone callus at 3 months postoperatively and bony healing time of the fracture(P<0.05).[Conclusion]The wrist arthroscopic assistance does improve the clinical outcomes of percutaneous screw fixation of scaphoid fracture.