切开复位钢板内固定联合植骨治疗腕舟骨骨折不愈合

Application of plate and screw internal fixation combined with bone grafting for the treatment of nonunion of scaphoid fractures

目的评估使用钢板螺钉内固定联合植骨治疗腕舟骨骨折不愈合的临床疗效。方法自2019年3月至2021年9月,我们对28例腕舟骨骨折不愈合的患者行切开复位钢板螺钉内固定联合植骨术治疗,其中8例为既往螺钉内固定术后不愈合行翻修手术,20例为腕舟骨骨折不愈合行初次手术。收集其临床和影像学资料,对比术前及随访时的视觉模拟评分(visual analogue scale,VAS)、握力、关节活动度及Mayo评分等。结果术后28例均获得随访,时间为12~49个月,平均26.4个月,腕舟骨骨折均愈合,时间为8~12周,平均10.2周。术后共12例取出内固定物,其中6例存在桡骨茎突与舟骨钢板撞击,另外6例要求行内固定取出。所有患者的VAS、握力、关节活动度及Mayo评分均较术前明显提升。结论钢板螺钉内固定系统联合植骨能为腕舟骨骨折愈合提供可靠的生物力学环境,是治疗腕舟骨骨折不愈合的有效方法。

Objective To evaluate the clinical efficacy of plate and screw internal fixation combined with bone grafting for the treatment of nonunion of scaphoid fractures.Methods From March 2019 to September 2021,28 patients with nonunion of scaphoid fractures were treated with plate and screw internal fixation combined with bone grafting.Among them,8 patients underwent revision surgery for nonunion after previous screw internal fixation surgery,and 20 patients underwent initial surgery for nonunion of scaphoid fractures.The clinical and imaging datawere collected,and the visual analog scale(VAS),grip strength,joint range of motion,and Mayo score before and during follow-up were compared.Results After surgery,all 28 cases were follow-up for a period of 12 to 49 months,with an average of 26.4 months.All 28 cases of scaphoid fractures healed after surgery,with a duration of 8 to 12 weeks,with an average of 10.2 weeks.A total of 12 patients underwent internal fixation removal after surgery,of which 6 had an impact between the radial styloid process and the scaphoid plate,and the other 6 required internal fixation removal.All patients′VAS,grip strength,joint range of motion,and Mayo scores were significantly improved compared to before surgery.Conclusion The combination of plate and screw internal fixation and bone grafting can provide a reliable biomechanical environment for the healing of scaphoid fractures,and is an effective method for treating nonunion of scaphoid fractures.