腕关节镜下克氏针联合螺钉植骨内固定治疗腕舟骨骨折不愈合

Arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation

目的探讨腕关节镜下克氏针联合螺钉植骨内固定治疗腕舟骨骨折不愈合的疗效。方法回顾分析2021年2月—2022年9月收治且符合选择标准的14例腕舟骨骨折不愈合患者临床资料。其中男13例,女1例;年龄17~54岁,平均32岁。受伤至手术时间6~15个月,平均9.6个月。术前舟骨骨折不愈合SladeGeissler分级:Ⅲ级3例、Ⅳ级8例、Ⅴ级3例。术前疼痛视觉模拟评分(VAS)为(5.9±1.0)分,改良Mayo腕关节评分为(53.2±9.1)分。其中舟骨骨折不愈合进行性塌陷2例,均为Ⅰ期。均采用腕关节镜下克氏针联合螺钉植骨内固定治疗。术后每月复查X线片观察骨折愈合情况;手术前后采用VAS评分和改良Mayo腕关节评分评价疗效。结果14例患者术后均获随访,随访时间6~14个月,平均8.4个月。患者骨折均愈合,愈合时间4~8个月,平均6.3个月。患者术后疼痛症状及腕关节功能较术前明显改善,末次随访时VAS评分为(2.4±1.3)分,改良Mayo腕关节评分为(87.1±6.7)分,与术前比较差异均有统计学意义(t=12.851,P<0.001;t=-14.410,P<0.001)。根据改良Mayo腕关节评分评价,获优9例、良3例、一般2例。结论腕关节镜下克氏针联合螺钉植骨内固定是治疗腕舟骨骨折不愈合的有效手术方式。

Objective To explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation.Methods The clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed.There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years.The time from injury to operation ranged from 6 to 15 months,with an average of 9.6 months.According to the Slade-Geissler classification of scaphoid fracture nonunion,there were 3 cases of gradeⅢ,8 cases of gradeⅣ,and 3 cases of gradeⅤ.The preoperative visual analogue scale(VAS)score was 5.9±1.0,and the modified Mayo wrist score was 53.2±9.1.There were 2 cases of scaphoid nonunion advanced collapse,both of which were stageⅠ.All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation,and the fracture healing was observed by X-ray film monthly after operation,and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation.Results All patients were followed up 6-14 months,with an average of 8.4 months.All fractures healed in 4-8 months,with an average of 6.3 months.The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation,and the VAS score at last follow-up was 2.4±1.3,and the modified Mayo wrist score was 87.1±6.7,which were significantly different from those before operation(t=12.851,P<0.001;t=−14.410,P<0.001).According to the modified Mayo wrist evaluation,9 cases were excellent,3 cases were good,and 2 cases were fair.Conclusion Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.