摘要
背景:由于舟状骨在腕部的特殊位置骨折难以获得稳妥的固定,加之其特殊的解剖及血液供应特点容易导致骨折不愈合甚至骨缺血性坏死。在腕部舟状骨新鲜骨折石膏固定和内固定治疗方法上依然存在不同的争议。目的:比较分析石膏固定和空心螺钉内固定修复腕部舟状骨新鲜骨折的功能恢复情况。方法:纳入新疆医科大学第一附属医院2012年3月至2014年3月收治的腕部舟状骨新鲜骨折22例,患者均为新鲜舟状骨腰部骨折,受伤时间2 h-12 d。患者术前X射线拍片示:未见腕部舟状骨塌陷、月骨周围脱位、缺血性骨坏死及骨性改变等表现。所有病例均为有移位、不稳定性骨折。根据患者意愿及手术方法选择等分为石膏组和空心螺钉组进行疗效对比分析,每组11例。随访时对两组患者进行Cooney腕关节功能评分。两组患者年龄分布、性别差异无显著性意义(P>0.05)。结果与结论:随访3-6个月对比分析石膏组和空心螺钉组患者腕关节功能Cooney评分,空心螺钉组优9例,良1例,可1例,差0例;石膏组优1例,良5例,可3例,差2例,空心螺钉组患者治疗后优良率为91%,石膏组患者治疗后优良率为55%,空心螺钉组显著高于石膏组(t=4.817,P<0.05)。提示虽然石膏固定在腕部舟状骨新鲜骨折上具有一定的疗效,但在修复后腕关节功能恢复方面,切开复位空心螺钉内固定疗效显著并且患者腕关节功能恢复较快。因此与石膏固定相比,切开复位空心螺钉内固定修复腕部新鲜舟状骨骨折更具优势。
BACKGROUND： The stable fixation is not available due to specific position of wrist scaphoid fracture, the fracture is prone to non-union and ischemic necrosis of bone due to specific anatomy and blood supply. The choice between plaster fixation and internal fixation in treatment of wrist scaphoid bone fresh fracture remains controversial.OBJECTIVE： To compare and analyze functional recovery of the wrist scaphoid bone fresh fracture after plaster fixation and internal fixation. METHODS： Twenty-two patients with wrist scaphoid bone fresh fracture were recruited from the First Affiliated Hospital of Xinjiang Medical University from March 2012 to March 2014, and the injury time was 2 hours to 12 days. Preoperative X-ray films revealed that, the involved patients had no wrist scaphoid bone collapses, lunate bone dislocation, ischemic necrosis of bone and osseous changes. All the cases showed shift, unstable fractures.According to the patient’s willing and the surgical method, the involved patients were divided into two groups, receiving plaster fixation and cannulated screw internal fixation respectively. Each group contained 11 cases.Wrist joint function was evaluated using Cooney score system. There was no significant difference in the age distribution and gender between the two groups（P 〉 0.05）. RESULTS AND CONCLUSION： At 3-6 months of follow-up, wrist joint function of patients in the two groups was compared and analyzed with Cooney scores. According to the Cooney scores, nine cases in internal fixation group were excellent, 1 good, 1 fair and none poor; one case in plaster fixation group was excellent, 5 good, 3 fair, and 2 poor. The excellent and good rate in the internal fixation group was significantly higher than that in the plaster fixation group（91%, 55%, t=4.817, P 〈 0.05）. Although plaster fixation has certain effects on wrist scaphoid bone fresh fracture, open reduction and canulated screw fixation has obvious effect and promotes the functional recovery of wrist joint. Compared with plaster fixation, open reduction and cannulated screw fixation has a superiority for treating wrist scaphoid bone fresh fracture.
出处
《中国组织工程研究》
CAS
北大核心
2015年第4期590-595,共6页
Chinese Journal of Tissue Engineering Research
