桡侧小切口多针固定自体骨移植治疗腕舟骨骨折不愈合

Treatment of scaphoid bone fracture nonunion with autogenous bone graft fixed with multipleKirschnerWires through small radial incision of carpal

目的探讨腕桡侧小切口入路多克氏针固定自体髂骨骨移植治疗腕舟骨骨折不愈合的临床效果。方法2008年1月~2018年1月,采用桡侧小切口多克氏针固定自体髂骨骨移植治疗腕舟骨骨折不愈合19例。男性15例,女性4例。年龄25~54岁,平均37.6岁。伤后就诊时间3~32个月,平均15.1个月。术后含拇指前臂石膏固定12~16周。结果切口均一期愈合。骨折愈合17例,不愈合2例,愈合率89.5%。临床愈合时间12~16周,平均14.5周。术后改良Mayo腕关节评分(76.3±8.7)较术前(54.1±9.6)有明显改善,χ^(2)=-6.780,P=0.000,差异有显著统计学意义。结论腕桡侧小切口多克氏针固定自体骨移植治疗腕舟骨骨折不愈合,损伤小、暴露充分、方法可靠。

Objective To investigate the clinical efficacy of scaphoid nonunion with autogenous bone graft fixed by multiple Kirschner Wires through small radial incision of carpal.Methods From January 2008 to January 2018,19 cases of scaphoid nonunion were treated with multiple Kirschner wires fixation and autologous bone grafting through small radial incision centered on the radial styloid process,including 15 males and 4 females.The age ranged from 25 to 54 years,with an average of 37.6 years.The treatment time of patients after injury ranged from 3 to 32 months,with an average of 15.1 months.After the operation,the thumb and forearm were immobilized with a tube cast for 12-16 weeks.Results All the incisions were healed in one stage.Fracture union occurred in 17 cases and non-union in 2 cases,union rate was 89.5%.Clinical healing time ranged from 12 to 16 weeks,with an average of 14.5 weeks.Postoperative modified Mayo wrist score(76.3±8.7)was significantly improved compared with preoperative score(54.1±9.6),χ^(2)=-6.780,P=0.000,with significant difference.Conclusions Multiple Kirschner wires fixation and autologous bone grafting through small radial incision of carpal is an effective method with less injury,full exposure and high fracture healing rate.