可吸收棒内固定治疗陈旧性腕舟骨骨折

目的探讨可吸收棒治疗陈旧性腕舟骨骨折的手术疗效。方法对17例陈旧性腕舟骨骨折,按Herbert分类:D1型4例,D2型11例,D3型2例,采用骨折切开复位自体松质骨植骨,可吸收棒内固定术。结果17例获得4~26个月随访,平均9个月。术后伤口均Ⅰ期愈合,骨折愈合时间8~19周,平均13周。腕关节活动范围掌屈[(49.5±8.5)°,x-±s,下同],(达健侧78.3%);背伸(41.5±4.5)°,(达健侧70.5%);桡偏(16.5±2.5)°,(达健侧57.1%);尺偏(24.5±5.5)°,(达健侧60.3%)。15例腕关节活动时无疼痛。2例有疼痛。腕部握力(24.7±3.1)kg,(达健侧83.2%)。术后X线片示17例均未发生腕骨性关节炎及舟骨缺血性坏死。结论可吸收棒治疗陈旧性舟骨骨折手术操作简单,固定牢靠,可缩短骨折愈合时间及提高骨折愈合率,是治疗陈旧性舟骨骨折的一种有效的手术方法。     

双空心螺钉内固定术治疗Herbert B型腕舟骨骨折

目的探讨采用2枚微型空心螺钉内固定术治疗腕舟骨骨折的临床疗效。方法对13例腕舟骨骨折采用双空心螺钉行切开复位内固定术,均选择掌侧入路,早期功能锻炼。术后评估腕部疼痛、腕关节活动度、手部握力及骨折愈合情况,并用Krimmer评分法评估疗效。结果 13例均获随访,随访时间12～32个月,平均15个月。骨折均一期愈合,治愈率为100%。愈合时间为4～9周,平均6周。11例活动度与健侧相同,无疼痛等不适感觉。2例桡偏和掌屈欠5°～10°,腕关节掌屈时感轻度疼痛,无其他并发症。按Krimmer评分法评估总体疗效:优11例,良2例。结论采用双空心螺钉切开复位内固定治疗腕舟骨骨折,愈合率高,功能恢复好,是治疗腕舟骨骨折的一种较好方法。     

带血管蒂桡骨茎突骨瓣移植及可吸收钉治疗腕舟骨骨折不愈合17例

目的探讨带血管蒂桡骨茎突骨瓣移植及可吸收钉治疗腕舟骨骨折不愈合的方法及疗效。方法采用带血管蒂桡骨茎突骨瓣植入及可吸收钉内固定治疗17例腕舟骨骨折不愈合患者,术后石膏固定拇指掌指关节固定于对掌位4～6周,早期康复训练。结果17例患者均达到骨性愈合,背伸45°～50°,掌屈55°～60°,手部握力平均提高2级。随访6～18个月,优14例,良2例,可1例,优良率94.1%。结论带血管蒂桡骨茎突骨瓣移植及可吸收钉治疗陈旧性舟骨骨折操作简便,创伤小,疗效好,易推广,为治疗腕舟骨陈旧性骨折的较好方法。     

经皮加压空心螺钉内固定治疗舟骨骨折

目的探讨经皮掌、背侧入路空心加压螺钉固定治疗腕舟骨骨折的手术方法及临床疗效。方法经皮掌、背侧入路治疗无移位腕舟骨骨折9例,B2型采用掌侧入路,B3型采用背侧入路。结果术后随访10~12个月,平均10.8个月,9例骨折均愈合,愈合时间2~4个月,平均3.1个月。患手握力恢复至健侧的80%以上,活动度达到健侧90%以上,无疼痛等不适感觉,没有并发症。恢复工作时间平均为7周。结论无移位(或轻度移位)的新鲜舟骨骨折,常规行CT检查以明确骨折分型,经皮加压螺钉固定,手术创伤小,根据骨折类型不需外固定或外固定时间较保守治疗缩短,愈合率高,治疗结果满意。     

加压螺钉治疗舟骨骨折的临床疗效

目的　评价加压螺钉内固定治疗舟骨骨折的临床疗效。方法　对 46例 (4 7侧 )舟骨骨折采用切开复位加压螺钉内固定治疗的患者 ,术后进行随访。从术后疼痛程度、腕关节活动度、手部握力、影像学检查、Krimmer腕关节评分和DASH(DisabilityofArm Shoulder Hand)问卷调查表等进行随访和疗效评估。结果　术后腕关节疼痛程度静息时为 2 ,用力时为 13。腕关节屈伸活动度 12 4°(达健侧 92 % ) ,尺桡偏5 7°(达健侧 91% ) ,平均握力 47kg(达健侧 90 % )。X线片及CT检查 :6例螺钉穿透骨皮质 ,4例发生腕关节炎 ,1例舟骨骨折不愈合及 1例畸形愈合。Krimmer评分总体疗效 :优 3 9侧 ,良 5侧 ,满意 3侧。DASH值为8 3。DASH问卷调查表结果显示 ,术后腕关节功能良好 ,仅有轻微不适症状。结论　应用切开复位加压螺钉内固定治疗舟骨骨折手术操作简便、疗效可靠。     

早期手术治疗经舟骨月骨周围骨折脱位的临床分析

目的 评价早期手术治疗经舟骨月骨周围骨折脱位的临床疗效.方法 15例经舟骨月骨周围骨折脱位的患者,采用切开复位加压螺钉和克氏针内固定.术后评估腕部疼痛、腕关节活动度、手部握力及骨折愈合,并用腕关节Krimmer评分法评估疗效.结果 13例获得6～12个月随访,平均9个月.2例出现静息痛,3例活动时疼痛.腕关节屈伸活动度（65±11）°,尺桡偏角度为（10±8）°,平均握力较健侧减少10%.X片检查3例腕关节炎,2例舟骨骨折近端骨质吸收致舟骨不愈合.11例腕舟骨愈合,平均愈合时间为4.8个月.Krimmer评分法评估总体疗效：优7例,良1例,可3例,差2例.结论 早期切开复位应用克氏针和加压螺钉同时内固定治疗经舟骨月骨周围骨折脱住手术方式可行、疗效可靠.     

逆行可吸收拉力螺钉内固定治疗腕舟骨骨折

目的：探讨逆行可吸收拉力螺钉内固定治疗腕舟骨骨折的手术疗效。方法：2001年12月至2007年12月,18例腕舟骨骨折,男12例,女6例;年龄17～40岁,平均26岁。腕舟骨腰部骨折10例,近端骨折8例。采用逆行可吸收拉力螺钉内固定治疗。结果：18例患者获随访,时间12～36个月,平均25个月。18例中有17例愈合,1例不愈合,平均愈合时间为13周,平均腕关节活动度为健侧的90%,握力为健侧的95%。14例无疼痛,3例轻度疼痛,另外1例不愈合有中度疼痛,除1例不愈合外,其余都能胜任原工作。按Cooney评分标准：总评分由术前的（68.2±1.5）分提高到术后的（88.7±1.2）分,术后各项评分明显高于术前（P〈0.05）;优9例,良8例,差1例。结论：逆行可吸收拉力螺钉内固定治疗腕舟骨骨折手术操作简单,对腕舟骨残存的血运破坏小,固定牢靠,可缩短骨折愈合时间及提高骨折愈合率,是治疗腕舟骨骨折的一种有效的手术方法。     

带血管蒂第一掌骨骨条移植及BMP复合物植入、内固定治疗腕舟骨骨不连

临床治疗腕舟骨陈旧性骨折 ,骨不连的手术方法已有较多报道[1～ 4 ] 。 1 997年以来 ,对 1 8例陈旧性腕舟骨骨折骨不连患者 ,采用以第一掌骨桡背侧动脉为蒂的第一掌骨骨条移植及骨形态发生蛋白复合物 (ＢＭＰ/ＦＳ)植入治疗 ,以促进骨折愈合。术后随访 6～ 2 4个月 ,疗效满意。1　临床资料1 1　一般资料　本组共 1 8例 ,男性 1 4例 ,女性 4例 ,年龄 1 9～ 51岁 ,平均 2 9岁。病程 8～ 2 4个月。均为腕舟骨腰部陈旧性骨折 ,骨不连。全部病例均有腕关节桡偏疼痛 ,活动受限。患手持物时疼痛 ,握力下降。患腕鼻烟窝及舟骨结节处明显压痛。Ｘ线…     

腕掌侧入路、Bold螺钉、植骨治疗无骨坏死的陈旧性腕舟骨骨折

目的 探讨腕掌侧入路、Bold螺钉、植骨治疗无骨坏死陈旧腕舟骨骨折的疗效.方法 我院自2004年对12例无骨坏死陈旧腕舟骨骨折病例采用腕掌侧入路、Bold螺钉、植骨治疗.结果 12例陈旧性舟骨骨折患者均获4个月～3年随访,术后4～11个月内骨性愈合,愈合率100%,腕部功能恢复良好.结论 对于无骨坏死陈旧腕舟骨骨折,采用腕掌侧入路、Bold螺钉、植骨治疗,效果良好.     

近排腕骨切除术治疗陈旧性经舟骨月骨周围骨折-脱位

目的报道近排腕骨切除术治疗陈旧性经舟骨、月骨周围脱位的临床效果。方法对 34例应用此手术的患者进行功能评价,平均随访5年3个月。结果29例腕部疼痛症状消失,5例仍有轻微腕部疼痛不适;腕关节屈伸活动度较术前增加了30°～50°;尺、桡偏活动较差,范围20°～30°;握力较健侧稍减弱;29例恢复了原来的工作,5例改为轻工作。结论近排腕骨切除术是治疗陈旧性经舟骨、月骨周围脱位的一种可靠有效的方法。     

Pronator quadratus pedicled bone graft for old scaphoid fractures

Delayed union or non-union of the scaphoid was treated by a bone graft on a pronator quadratus pedicle in eight cases. This produced earlier union than the Russe procedure. The procedure is simple and is recommended for old un-united scaphoid fractures.     

Technical factors related to Herbert screw fixation

We reviewed 24 patients treated for an acute fracture or a nonunion of the scaphoid bone using the Herbert screw. Mean follow-up in 22 patients who returned for examination was 17 months. The overall union rate was 67% for both acute fractures and nonunions. Fracture healing correlated strongly with technical factors of the procedure. The fracture failed to heal in seven of nine cases with poor scaphoid realignment, inaccurate jig placement, or improper screw length for a nonunion rate of 78%. Conversely, without these technical problems, 14 (93%) of 16 fractures achieved union. Applying Herbert's criteria, a satisfactory rating for clinical function was achieved in 59% of all patients and for patient satisfaction in 68% of all patients. Although the postoperative immobilization period was reduced using the screw, the final functional result in our nonunions was similar to that reported for the Russe bone grafting procedure. Appropriate modifications of the standard technique and recognition of equipment limitations may improve union rates.     

Scaphoid nonunion

Scaphoid nonunion is common, but the exact pathophysiology of this complication is unclear. Explanations include lack of treatment, poor initial treatment, delay in diagnosis, synovial fluid dynamics, precarious vascularity, fracture displacement, and carpal instability. Currently, the diagnosis is best confirmed by classic changes on plain radiographs, instability testing, arthrography, and arthroscopy in selected cases. Nine carpal bones are not benign. The natural history of scaphoid nonunion is one of progressive arthritis. Attempts at obtaining bony healing are therefore recommended. In treating established nonunions without arthritis, the Russe bone graft technique is the mainstay of treatment. A union rate of 90 per cent is to be expected. Electrical stimulation is an alternative when there is no synovial pseudarthrosis or scaphoid collapse deformity, or if a previous Russe graft has failed. If a significant humpback scaphoid or collapse deformity is present, internal fixation with the Herbert screw and scaphoid reconstruction with a bone graft are our choices. Healing rates are less than those with the Russe graft, but one may achieve improved motion of the wrist and earlier return to function. When scaphoid nonunion is accompanied by degenerative arthritis, salvage procedures are recommended. Radial styloidectomy is a simple procedure that will preserve motion and buy time. Soft tissue interposition with excision of a small proximal pole is useful, particularly if no collapse deformity is present. Silicone replacement alone has fallen into increasing disfavor because of the high incidence of subluxation and silicone synovitis. Combining silicone replacement with intercarpal fusion (the SLAC procedure) may lessen these complications. Proximal row carpectomy is another procedure that may preserve motion, though often at the expense of weakness, particularly in the younger patient requiring significant grip strength. In these cases, standard wrist fusion seems the most predictable alternative.     

可吸收螺钉治疗陈旧性腕舟状骨骨折的临床应用

目的 通过自体桡骨远端植骨、可吸收螺钉固定治疗陈旧性腕舟状骨骨折的临床应用,探讨腕舟状骨骨折治疗新方法.方法 2002年1月-2007年5月,应用自体桡骨远端松质骨植骨,聚-DL-乳酸可吸收螺钉治疗陈旧性腕舟状骨骨折18例.其中男13例,女5例;年龄17～41岁.均有手掌撑地外伤史.鼻烟窝及腕舟状骨结节区压痛,握力下降.腕关节背伸(36±2)°,掌屈(30±3)°,桡偏(8±3)°,尺偏(13±2)°结果 18例术后随访3～50个月,平均15.7个月.18例骨折全部愈合,愈合时间为术后3～8个月,平均4.5个月.16例腕关节背伸(68±2)°掌屈(65±3)°,桡偏(15±3)°,尺偏(28±5)°,腕关节活动无疼痛及不适感,无力症状消失.另2例腕关节背伸(40±8)°,掌屈(35±6)°,桡偏(8±5)°,尺偏(12±5)°,与术前相比无明显改善,日常生活中偶有疼痛,腕背伸力量减弱.未发生术后感染及内固定物断裂.结论 可吸收螺钉作为一种新的生物内固定材料治疗陈旧性腕舟状骨骨折,具有生物相容性好、促进骨折愈合、无需二次手术取出等优点.     

应用改制加压螺钉内固定治疗陈旧性腕舟骨骨折

目的探讨普通螺钉简单改制成加压螺钉内固定治疗陈旧性腕舟骨骨折的临床疗效。方法1995年1月～2002年12月采用改制的加压螺钉内固定治疗陈旧性腕舟骨骨折25例,其中延迟愈合17例,骨不连接、假关节形成8例。将普通的皮质骨螺钉去掉部分螺纹后,使之变成具有加压作用的螺钉,通过简单的手术器械将其拧入复位后的舟骨内,对舟骨断端加压固定。结果19例获得随访,时间1～6年(平均3年),14例骨折愈合,平均愈合时间7个月,腕关节活动范围在106°～128°之间；3例未愈合,2例舟骨近端塌陷变形。结论改制加压螺钉治疗腕舟骨骨折具有对骨折端有加压作用、固定稳固、可经关节面置入、对关节干扰小、材料易取及操作简单等优点,是治疗陈旧性腕舟骨骨折的有效方法。     

The prognostic value and reproducibility of the radiological features of the fractured scaphoid

We investigated whether the radiological features of the fractured scaphoid could be reproducibly measured and used to predict the likelihood of union with conservative plaster cast immobilization. We found that the inter- and intra-observer reproducibility of the Compson, Herbert and Russe classification systems were only fair and that none predicted fracture union. Assessments of fracture level, comminution and displacement showed moderate inter- and intra-observer reproducibility but did not predict the likelihood of fracture union. We conclude that the radiological features of acute scaphoid fractures cannot be used to predict the likelihood of fracture union.     

桡动脉茎突返支为蒂桡骨茎突骨瓣植入术治疗舟骨骨折不愈合

目的总结以桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合的临床效果。方法2000年3月~2005年6月,对18例舟骨骨折不愈合的患者,以桡动脉茎突返支为蒂在桡骨茎突掀起1.5cm×3.5cm×0.5cm的骨瓣,植入沿舟骨纵轴跨越骨折线所凿同等大小的骨槽内进行治疗。其中男15例,女3例。年龄18~39岁。舟骨腰部骨折11例,近侧1/3骨折7例,其中5例舟骨近端骨折块伴缺血坏死。腕关节活动疼痛,尤以背伸及桡偏时明显,鼻烟窝处有压痛,腕关节活动受限,X线片示10例患者有骨折端硬化及囊性变,骨折线明显加宽。结果术后18例舟骨骨折均愈合,其中5例合并缺血坏死的舟骨骨折块重新成活,骨折平均愈合时间为4个月。术后获随访1~5年,患者腕关节活动良好,腕背伸时无疼痛,日常生活和工作无影响。结论采用桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合及近端骨折块缺血坏死,操作简便,治疗有效,具有一定临床应用价值。     

陈旧性舟骨骨折的手术疗效分析

目的 探讨陈旧性舟骨骨折的治疗方法及临床疗效.方法 2005年6月至2008年6月,对16例陈旧性舟骨腰部骨折患者,采用腕关节背侧入路,去除骨折处硬化骨后加自体骨植骨,并用Herbert螺钉加克氏针进行固定.术后定期复查X线片,观察骨折愈合情况.根据Krimmer评分评估腕关节功能.结果 术后16例获得随访(平均为8.5个月),所有骨折均获得愈合,平均愈合时间为16周.按Krimmer评分:优8例,良5例,可2例,差1例;优良率达81.3%.结论 对于陈旧性舟骨骨折,通过自体骨植骨及Herbert钉加克氏针内固定,能取得较理想的临床效果.

Abstract：

Objective To discuss the surgical methods and treatment effects of old scaphoid fractures.Methods From June 2005 to June 2008, 16 cases of old scaphoid waist fractures were treated by debridement of necrotic bone, autologous bone graft and Herbert screw plus Kirschner wire internal fixation through a dorsal approach. Postoperative X-rays were taken on a regular basis to observe fracture healing. Wrist function was evaluated according to Krimmer score. Results Postoperatively the 16 cases were follow-up for an average of 8.5 months. All the fractures healed and the average healing time was 16 weeks. Krimmer score determined wrist function to be excellent in 8 cases, good in 5 cases, fair in 2 cases and poor in 1 case. The overall satisfactory rate was 81.3%. Conclusion Herbert screw and K-wire internal fixation combined with autologous bone graft can attain good clinical results in the treatment of old scaphoid fiactures at the waist.     

应用带血运桡骨茎突骨瓣治疗腕舟骨骨折和骨缺损

目的探讨以桡动脉返支为蒂桡骨茎突骨瓣治疗腕舟骨骨折和骨缺损的治疗效果。方法对19例第2、3型腕舟骨骨折患者行桡动脉返支为蒂的桡骨茎突骨瓣移植,克氏针交叉加压固定治疗舟骨嵌入骨折13例;同时应用带血运的桡骨瓣重建因磨损、吸收所致的舟状骨缺损6例。结果19例腕舟骨骨折和骨缺损患者,X线示骨折全部骨性愈合,舟状骨形态恢复正常。采用改良Gartland—Werley腕关节功能评分标准进行评估：优16例,良2例,中1例。结论桡动脉返支为蒂桡骨茎突骨瓣移植治疗腕舟骨骨折和骨缺损效果肯定。     

Scaphoid kinematic behavior after division of the transverse carpal ligament

PURPOSE: The effect that carpal tunnel release (CTR) has on scaphoid motion has not been reported. Accordingly the purpose of this study was to determine the flexion/extension behavior of the scaphoid during global wrist radial/ulnar deviation before and after division of the transverse carpal ligament (TCL). METHOD: In this study we examined the in vitro kinematics of the scaphoid during wrist deviation in 6 cadaver forearms both before and after the division of the TCL using a computerized camera monitoring system. The specimens were evaluated in 13 different positions, from 20 degrees of radial deviation to 40 degrees of ulnar deviation at increments of 5 degrees. RESULTS: The data indicate that the difference in scaphoid position after TCL division is statistically significant when the wrist is in ulnar deviation of 15 degrees or greater. In addition a significant difference in scaphoid extension between pre- and post-TCL division conditions was found at 5 degrees of radial deviation as well as at 5 degrees or more of ulnar deviation and increased with increasing ulnar deviation. CONCLUSIONS: Scaphoid kinematics are altered considerably in radial-ulnar deviation after division of the TCL. This alteration may have long-term consequences and contribute to commonly seen post-CTR symptoms.