摘要
目的 探讨切开复位骨瓣植骨克氏针内固定治疗陈旧性手舟骨骨折的临床效果及对腕关节功能的影响。方法 选取2019年1月至2021年1月中国人民解放军联勤保障部队第九〇八医院骨科收治的120例陈旧性手舟骨骨折患者,采用随机数字表法分为观察组和对照组,每组60例。对照组采用克氏针内固定联合松质骨植骨治疗,观察组采用切开复位骨瓣植骨克氏针内固定治疗。比较两组的治疗效果,实验室检查指标,治疗前后的腕关节患者自行评估量表(patient-rated wrist evaluation,PRWE)、上肢简化Fugl-Meyer评定量表(Fugl-Meyer assessment,FMA)、Wolf运动功能测试(Wolf motor function test,WMFT)、Mayo腕关节评分(Mayo wrist score,MWS)、Barthel指数(Barthel index,BI)和改良Rankin量表(modified Rankin scale,mRS)评分,以及术后并发症发生情况。结果 观察组治疗总有效率为93.33%,明显高于对照组的66.67%,差异有显著性(P<0.05)。治疗后观察组的C反应蛋白、血尿酸、红细胞沉降率、白细胞计数、血红蛋白、白细胞介素-6、α1-酸性糖蛋白水平均低于对照组,差异有显著性(P<0.01)。治疗前两组患者的PRWE评分、FMA评分、WMFT评分、MWS评分、BI和mRS评分比较差异无显著性(P>0.05);治疗后两组患者的PRWE评分、mRS评分明显低于治疗前,且观察组明显低于对照组,而FMA评分、WMFT评分、MWS评分、BI明显高于治疗前,且观察组明显高于对照组,差异均有显著性(P<0.05)。观察组的术后并发症发生率(3.33%)明显低于对照组(16.67%),差异有显著性(P<0.05)。结论 切开复位骨瓣植骨克氏针内固定治疗陈旧性手舟骨骨折可显著改善患者腕关节功能、手功能、运动功能及日常生活活动能力,且安全性较高。
Objective To explore the clinical effect of open reduction,bone grafting and Kirschner wire fixation in the treatment of old scaphoid fracture and its influence on wrist joint function.Method From January 2019 to January 2021,120 patients with old scaphoid fracture admitted to the Department of Orthopedics,No.908 Hospital of China People’s Liberation Army Joint Logistics Support Force were randomly divided into observation group and control group,with 60 cases in each group.The control group was treated with Kirschner wire internal fixation combined with cancellous bone grafting,while the observation group was treated with open reduction and bone flap grafting and Kirschner wire fixation.The therapeutic effect,laboratory examination indexes,patient-rated wrist evaluation(PRWE)and Fugl-Meyer assessment of upper limbs before and after treatment were compared between the two groups.FMA,Wolf motor function test(WMFT),Mayo wrist score(MWS),Barthel index(BI)and modified Rankin scale(mRS),as well as postoperative complications.Result The total effective rate of the observation group was 93.33%,which was significantly higher than that of the control group(66.67%),and the difference was significant(P<0.05).After treatment,the levels of C-reactive protein,serum uric acid,erythrocyte sedimentation rate,white blood cell count,hemoglobin,interleukin-6 andα1-acidic glycoprotein in the observation group were lower than those in the control group,with significant differences(P<0.01).There was no significant difference in PRWE score,FMA score,WMFT score,MWS score,BI score and mRS score between the two groups before treatment(P>0.05).After treatment,the scores of PRWE and mRS in the two groups were significantly lower than those before treatment,and the scores of FMA,WMFT,MWS and BI in the observation group were significantly higher than those in the control group,with significant differences(P<0.05).The incidence of postoperative complications in the observation group(3.33%)was significantly lower than that in the control group(16.67%),and the difference was significant(P<0.05).Conclusion Open reduction,bone grafting and Kirschner wire fixation for old scaphoid fracture could significantly improve wrist joint function,hand function,motor function and activities of daily living,and it was safe.
作者
郭朝剑
赵岚
李浩
Guo Chaojian;Zhao Lan;Li Hao(Department of Orthopedics,908th Hospital of Chinese PLA Joint Logistic Support Force,Jiangxi Nanchang 330001,China)
出处
《中国医刊》
CAS
2023年第11期1194-1199,共6页
Chinese Journal of Medicine
关键词
陈旧性手舟骨骨折
克氏针内固定
切开复位骨瓣植骨
桡骨茎突筋膜骨瓣
腕关节
Old scaphoid fracture
Kirschner wire internal fixation
Open reduction and bone grafting
Radial styloid fascia bone flap
Wrist joints
