镜下清创植骨背侧经皮螺钉固定陈旧性腕舟骨骨折

Arthroscopic bone grafting and dorsal percutaneous screw fixation of old scaphoid fracture

[目的]介绍镜下清创植骨背侧经皮螺钉固定治疗腕舟骨陈旧性骨折的手术方法及疗效。[方法]2021年7月—2023年9月对12例腕舟骨陈旧性骨折患者采用上述手术治疗。镜下彻底清除断端纤维瘢痕及硬化骨。于背侧入路沿舟骨长轴置入导针,确认导针位置准确后,镜下经套管向断端植入松质骨,最后沿导针置入螺钉固定。[结果]12例患者随访时间平均(12.7±2.8)个月,与术前相比,末次随访时VAS评分[(5.1±0.8),(1.1±0.6),P<0.001]、改良mayo腕关节功能评分[(54.6±6.9),(86.7±6.8),P<0.001]显著改善。末次随访时骨折均愈合,愈合时间(5.7±1.5)个月。[结论]镜下清创植骨背侧经皮螺钉固定治疗腕舟骨陈旧性骨折,可微创完成清创和植骨,避免对舟骨血运的二次破坏,愈合率高,疗效满意。

[Objective]To introduce the surgical technique and preliminary consequence of arthroscopic debridement and bone grafting,combined with dorsal percutaneous screw fixation for old scaphoid fracture.[Methods]A total of 12 patients received abovementionedsurgical treatment for the old scaphoid fracture from July 2021 to September 2023.As the fibrous scar and sclerotic bone at the fractureends were completely removed under the arthroscope,a guide pine was placed along the long axis of scaphoid through the dorsal approach.After confirming the accurate position of the guide pin,the cancellous bone autografts were inserted into the bone gap through the cannulaunder the arthroscope,and finally a cannulated screw was placed along the guide pin for fixation.[Results]All the 12 patients were fol-lowed up for an average of(12.7±2.8)months.Compared with those preoperatively,the VAS scores[(5.1±0.8),(1.1±0.6),P<0.001],Mayowrist function score[(54.6±6.9),(86.7±6.8),P<0.001]improved significantly at the last follow-up.In addition,all patients got the fractureshealed well with a mean healing time of(5.7±1.5)months.[Conclusion]The arthroscopic debridement,bone grafting and dorsal percutaneous screw fixation for the treatment of old scaphoid bone fracture do achieve minimally invasive debridement and bone grafting,avoid secondary damage to scaphoid blood flow,and have high healing rate and satisfactory outcome.