背侧与掌侧入路治疗腕舟骨陈旧性骨折、骨不连疗效比较

Comparison of dorsal and volar approaches in the treatment of old scaphoid fracture and nonunion

目的:研究背侧与掌侧入路治疗腕舟骨陈旧性骨折、骨不连疗效。方法:选取深圳市宝安区石岩人民医院42例腕舟骨陈旧性骨折或骨不连患者作为研究对象,按随机数字表法分为两组,每组各21例。背侧入路组开展经背侧入路行腕舟骨陈旧性骨折、骨不连切开复位内固定、自体骨移植术。掌侧入路组实施经掌侧入路行腕舟骨陈旧性骨折、骨不连切开复位内固定、自体骨移植术。术后持续跟踪随访6个月,比较两组手术时间、骨折愈合时间、功能康复程度以及术后并发症发生情况。结果:背侧入路组手术时间为(73.45±12.33)min,长于掌侧入路组的(64.21±10.95)min,差异有统计学意义(P<0.05);而骨折愈合时间为(9.73±1.94)w,与掌侧入路组的(9.66±1.82)w相比,差异无统计学意义(P>0.05)。背侧入路组腕关节功能Mayo评分优良率为95.24%,略高于掌侧入路组的85.71%,但两组比较差异无统计学意义(P>0.05)。两组术后骨折不愈合、腕舟骨缺血性坏死及腕部活动时疼痛不适发生率比较,差异无统计学意义(均P>0.05)。结论:背侧与掌侧入路治疗腕舟骨陈旧性骨折、骨不连疗效相当,且安全性亦无明显差异,均可促进患者的功能康复,然而,掌侧入路方式具有手术时间较短的优势。

Objective To compare the efficacy of dorsal and volar approaches in the treatment of old scaphoid fractures and nonunion.Method 42 patients with old scaphoid fracture or nonunion were selected as the research objects.They were randomly divided into two groups,with 21 cases in each group.Back access block group underwent open reduction and internal fixation of old scaphoid fracture,nonunion and autologous bone transplantation through dorsal approach.Volar approach obstruction group underwent open reduction and internal fixation of old scaphoid fracture,nonunion and autologous bone transplantation through volar approach.The operation time,fracture healing time,functional rehabilitation and postoperative complications were compared between the two groups.Results The operation time in back access block group was(73.45±12.33)min,which was longer than that in volar approach obstruction group(64.21±10.95)min(P<0.05);The fracture healing time was(9.73±1.94)weeks,which was not significant compared with(9.66±1.82)weeks in volar approach obstruction group(P>0.05).The excellent and good rate of Mayo score of wrist function in back access block group was 95.24%,which was slightly higher than 85.71%involar approach obstruction group,but there was no significant difference between the two groups(P>0.05).There was no significant difference in the incidence of postoperative fracture nonunion,ischemic necrosis of carpal scaphoid and pain and discomfort during wrist movement between the two groups(all P>0.05).Conclusion The curative effect of dorsal and volar approaches in the treatment of old carpal scaphoid fractures and nonunion is the same,and there is no significant difference in safety.They can promote the functional rehabilitation of patients.However,the volar approach has the advantage of short operation time.