经皮微创Herbert螺钉内固定治疗腕舟骨腰部骨折

目的探讨闭合复位掌侧入路经皮微创Herbert螺钉内固定治疗新鲜腕舟骨腰部骨折的疗效。方法回顾性分析2014年9月至2017年9月闭合复位经皮掌侧入路Herbert螺钉内固定治疗的15例新鲜腕舟骨腰部骨折患者,其中男12例,女3例;年龄23~48岁,平均(36.5±3.5)岁。按Herbert骨折分型,A2型9例,B2型6例。腕托或石膏托固定2~3 d后开始腕关节活动,定期复查腕关节正侧位片及舟骨片了解骨折愈合情况,按照Krimmer评分标准对腕关节功能评定。结果15例患者均获得随访,随访时间12~18个月,平均(13.5±1.2)个月。所有病例骨折均愈合,愈合时间8~12周,平均为(10.5±1.5)周。Krimmer评分,13例100分,2例90分,优良率100%。结论经皮Herbert螺钉内固定术是治疗新鲜腕舟骨腰部骨折有效的微创方法,固定牢靠,允许早期功能锻炼,临床疗效满意。     

掌侧经皮Herbert螺钉微创治疗腕舟骨骨折11例报告

目的探讨经皮Herbert螺钉微创内固定治疗新鲜腕舟骨骨折的疗效。方法 2012年9月~2016年9月我科采用掌侧经皮导针定位Herbert螺钉内固定治疗11例新鲜腕舟骨骨折(Herbert分型A2型8例,B2型2例,B3型1例)。结果手术时间45~80 min,平均65 min;术中出血2~30 ml,平均11 ml。术中透视及术后X线片均证实骨折复位良好,螺钉位置良好,切口术后2周拆线,均愈合良好。11例随访3~18个月,平均8个月,骨折均骨性愈合。按改良Mayo腕关节功能评分,优9例,良1例,可1例,优良率90.9%(10/11)。结论对新鲜腕舟骨骨折采用经皮闭合复位Herbert螺钉内固定治疗效果满意。     

闭合复位经皮空心螺钉固定治疗Herbert B1、B2型腕舟状骨骨折

目的探讨闭合复位经皮空心螺钉固定治疗轻微移位腕舟状骨骨折的临床疗效。方法对15例Herbert B1、B2型腕舟状骨骨折患者采用闭合复位经皮空心螺钉固定治疗。术后定期摄腕关节X线片评价骨折愈合情况,采用改良Mayo腕关节功能评分及疼痛VAS评分评价功能情况。结果 15例均获得随访,时间6~24个月。患者骨折愈合时间6~12周,未出现骨不愈合及骨坏死。末次随访时,Mayo评分80~100分,其中优11例,良4例;VAS评分为0~3分。结论闭合复位经皮空心螺钉固定创伤小,能最大程度保护舟状骨周围血供,有效避免了舟状骨坏死的发生,且固定牢靠,允许早期功能锻炼,术后功能恢复优良,是治疗Herbert B1、B2型腕舟状骨骨折的有效方法。     

Bold螺钉治疗新鲜腕舟骨骨折疗效分析

目的探讨使用Bold螺钉内固定治疗新鲜腕舟骨骨折的疗效。方法对本院2004年1月-2007年6月期间采用Bold螺钉内固定治疗的19例新鲜腕舟骨骨折病例进行回顾性分析。骨折根据Herbert分型分为B2型骨折16例,B4型骨折3例。结果19例患者均获得随访,随访时间为7～22个月,平均11个月。骨折均获骨性愈合。末次随访时用改良Mayo法对腕关节功能进行评估,优12例,良5例,可2例,优良率为89．5％。结论对于不稳定的新鲜腕舟骨骨折（Herbert分型B型）,采用Bold螺钉内固定治疗可减少骨折不愈合率,促进腕关节功能恢复,改善预后。     

经皮Herbert螺钉内固定技术治疗舟状骨骨折

目的 总结应用Herbert空心钉经皮微创手术治疗治疗舟状骨骨折的手术方法及疗效.方法 C臂下闭合复位后经皮Herbert螺钉内固定治疗新鲜舟状骨骨折患者l4例,按改良Herbert舟状骨骨折分型：A2型3例,B2型8例,B3型3例.结果 14例患者术后均获得随访,时间6～12个月.X线片示：内固定均无松动,骨折I期愈合.gsimmer评分总体疗效：优8例,良2例.满意4例,骨愈合时间为术后6.8～10.2周,平均8周.14例患者术后均获得随访,时间6～12个月,平均9个月.术后患者切口均Ⅰ期愈合.本组病例无舟状骨缺血性坏死.末次随访时腕关节功能较术前显著改善.结论对于一些能闭合复位的新鲜腕舟状骨骨折,C臂下手法复位后应用Herbert螺钉经皮内固定技术是一种微创、并发症较少、疗效可靠的手术方法.     

早期切开复位Herbert螺钉内固定治疗经舟骨月骨周围脱位

目的 评价早期切开复位、Herbert螺钉内固定治疗经舟骨月骨周围脱位的临床效果.方法 早期采用切开复位、Herbert螺钉内固定治疗新鲜经舟骨月骨周围脱位8例,术后随访X线片了解骨折愈合情况及腕关节轴线恢复情况.Cooney腕关节评分法评价术后腕关节功能恢复程度,DASH问卷调查表行术后腕关节功能自我评价.结果 术后随访时间为7～35个月,平均14个月.根据Cooney腕关节评分:优3例,良2例,中2例,差1例;平均评分值为76.DASH评分值为27.X线片检查舟骨完全愈合,腕关节轴线恢复好.结论 早期切开复位Herbert螺钉内固定能达到舟骨解剖复位、恢复腕关节轴线,术后功能恢复较好,是治疗新鲜经舟骨月骨周围脱位较好的方法.     

应用Herbert螺钉内固定治疗腕舟骨骨折

目的介绍用Herbert螺钉内固定治疗不稳定型腕舟骨骨折及腕舟骨骨折骨不连的疗效.方法 1992年12月至1996年12月,用Herbert螺钉内固定治疗不稳定型腕舟骨骨折20例,腕舟骨骨折骨不连14例.结果不稳定型腕舟骨骨折失访5例,15例术后平均随访12.8个月,骨折全部愈合;腕关节活动范围在106°～128°之间.腕舟骨骨折骨不连14例术后平均随访18.3个月,骨折愈合率为85.7%.结论 Herbert螺钉治疗腕舟骨骨折具有对骨折端的加压作用、固定稳固、可经关节面置入、无需取出等优点.     

腕关节镜联合机器人导航技术在经舟骨月骨周围背侧脱位治疗中的应用

目的探讨腕关节镜辅助下复位经舟骨月骨周围背侧脱位, 机器人导航经皮内固定舟骨的临床疗效。方法我科自2019年11月至2021年11月对7例经舟骨月骨周围背侧脱位患者, 采用腕关节镜辅助复位, 机器人导航下经皮空心加压螺钉内固定舟骨, 克氏针经皮内固定月骨三角骨。术后功能位支具固定, 定期摄X线片和腕关节CT观察骨折愈合情况。结果 7例患者均获得随访, 时间为8～20个月, 平均13.5个月。7例患者舟骨均获得愈合, 亦无月骨坏死及舟月、月三角分离发生。采用改良Mayo腕关节评分标准评定:优6例, 良1例。结论腕关节镜联合机器人导航治疗经舟骨月骨周围背侧脱位, 复位精准, 螺钉位置满意, 疗效可靠, 是一个值得推荐的治疗方法。     

微创手术治疗舟状骨骨折的早期疗效

目的总结应用Herbert空心钉经皮微创手术治疗治疗舟状骨骨折的手术方法及疗效。方法 2009年3月至2011年5月,采用闭合复位经皮打入导针Herbert空心螺钉内固定治疗16例舟状骨骨折患者。全部是男性病例,年龄20～49岁,平均41岁。全部为腰部骨折。受伤至手术时间2～7天,平均4天。结果术后患者切口均Ⅰ期愈合。15例获随访,随访时间6～12个月,平均9个月。X线片检查示术后45～80天骨折达骨性愈合,平均62天。本组病例无舟状骨缺血性坏死。末次随访时腕关节功能较术前显著改善。Mayo腕关节功能评分,获优12例,良2例,中1例。结论应用Herbert空心钉经皮微创加压固定稳定牢靠,是治疗舟状骨骨折的有效方法之一。     

经皮舟骨结节入路Herbert螺钉内固定治疗非移位性腕舟骨骨折

目的探讨Herbert螺钉治疗腕舟骨骨折的临床效果。方法 2010年1月-2014年7月,采用Herbert螺钉微创治疗15例腕舟骨骨折。术中结节部小切口入路,采用克氏针闭合临时固定、导向针一次性穿入、Herbert螺钉内固定技术。结果 15例骨愈合时间为术后7.5～10周,平均8.5周。患者均获随访,随访时间8～22个月,平均12个月。14例术后患手握力恢复至健侧的87.4%(82%～94%),患侧腕关节屈伸活动度恢复至健侧的86.5%(84%～98%)。除1例患者体力劳动后自觉有轻度腕痛改变原工作外,余病例术后疼痛消失,均恢复原工作。所有患者腕掌侧舟骨结节小切口均Ⅰ期愈合,无感染等并发症发生。结论经皮腕掌侧舟骨结节入路Herbert螺钉内固定是一种微创、骨折愈合率高、并发症相对较少的舟骨骨折有效治疗方法,值得推广应用。     

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.     

Clinical result of operative treatment for scaphoid non-union in the skeletally immature: percutaneous versus open procedure

This article is a retrospective study of 13 cases of scaphoid non-union in skeletally immature patients. For the fracture fixation, three cases of stable fibrous union with minimal sclerosis, without deformity or cystic changes were considered for the percutaneous Herbert screw fixation. Ten cases were managed with the open reduction and internal fixation with or without bone grafting. The average union time was 10.5 weeks post-operatively. The average union time was lesser in percutaneous Herbert screw fixation group (nine weeks) than open procedure group (11.5 weeks). All cases achieved union without any supplemental procedures. According to Cooney's clinical scoring, 12 cases were rated excellent result and one good result. The percutaneous Herbert screw fixation for scaphoid non-union in skeletally immature patients can be a good treatment option when it is fibrous union with no deformity.     

Percutaneous screw fixation for unstable scaphoid fractures

BACKGROUND: The technique of percutaneous screw fixation, with increasing popularity, has been successfully conducted in non-displaced, stable scaphoid fractures resulting in shortened immobilization duration and prompt functional retrieval. The purpose of this study was to evaluate the surgical technique and to explore the potential benefits of using percutaneous screw fixation in unstable scaphoid fractures. METHODS: Eleven of 97 patients with scaphoid fractures surgically treated between 1994 and 2002 were enrolled in this study. All were acute unstable fractures and underwent closed reduction and percutaneous screw fixation. All the records were meticulously reviewed and reported, including the complete radiographic examination before and after operation, time to fracture union, wrist motion, grip strength, and time of return to work, as well as overall patient satisfaction at the time of the most recent follow-up. RESULTS: Eleven fractures in an equal number of patients were followed up for a mean period of 1.6 years. All fractures acquired radiographic union in an average of 10.6 weeks. The modified Mayo Wrist score averaged 88.2. The functional result was ranked as excellent in 6 patients, and good in 5 patients. All returned to work or the pre-injury level of activity, and were satisfied with the surgical outcome. CONCLUSION: The technique of percutaneous screw fixation was successfully used to treat 11 unstable scaphoid fractures. The encouraging outcome of this treatment option and the prompt functional recovery deserve further investigation. Further randomized prospective studies to explore the specific indications and ubiquitous benefits of the technique presented herein are recommended.     

Open reduction and internal fixation of acute displaced scaphoid waist fractures

Fourteen consecutive patients with acute displaced scaphoid waist fractures were treated with open reduction and internal fixation. The operative technique consisted of anatomic reduction of the displaced scaphoid waist fracture, correction of carpal instability, radial bone grafting for comminution, and internal fixation with K-wires or Herbert screw. The patients were evaluated an average of 26 months (range, 4-48 months) after surgery. Thirteen of the 14 (93%) fractures united. The average time to union was 11.5 weeks (range, 8-20 weeks). Fracture union was confirmed with trispiral tomography. Final radiographic assessment consistently revealed a healed scaphoid fracture, restored intrascaphoid alignment, and no evidence of carpal instability. All patients regained functional wrist range of motion (wrist extension, 57 degrees; wrist flexion, 52 degrees ) and grip strength. Open reduction and internal fixation of acute displaced scaphoid waist fractures restores scaphoid alignment and leads to predictable union. Early operative intervention avoids malunion and carpal instability that often occurs with closed management of these complex fractures.     

Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw

BACKGROUND: A fractured scaphoid is a common disabling injury occurring in contact sports. This study was designed to evaluate the therapeutic outcome of Herbert screw fixation for scaphoid fracture in young athletes. METHODS: Thirty athletes with 30 scaphoid fractures were treated. According to the Herbert classification, 10 were classified as acute fracture (group I), 6 as fibrous union (group II) and 14 as pseudoarthrosis (group III). Twenty scaphoid non-unions were due to missed diagnosis or unsuccessful immobilisation. RESULTS: Bony union was evident at an average of 9.2, 8.0 and 11.9 weeks postoperatively in groups I, II and III, respectively, and times for returning to sports were 10.7, 14.0 and 22.9 weeks. The clinical outcome assessed using the Mayo wrist score was excellent in groups I (97.5 points) and II (93.3) and good in group III (85.4). CONCLUSION: Early definitive diagnosis and treatment can allow early return to sports in young athletes. The Herbert screw technique produces an excellent clinical result for scaphoid fracture.     

Pediatric scaphoid nonunion

PURPOSE: To report the outcome of pediatric scaphoid nonunions treated with a Herbert screw and bone graft. METHODS: This is a retrospective review of 12 cases of scaphoid nonunion in 12 skeletally immature patients treated with a uniform approach consisting of open reduction, iliac crest bone grafting and Herbert screw fixation. All patients were boys and presented with nonunions of the scaphoid waist. The final follow-up evaluation was at a mean of 32 months, ranging from 22 to 45 months, and consisted of assessing anatomic snuffbox tenderness, wrist arc of motion, grip strength, calculation of the Modified Mayo Wrist score, and assessment of union based on plain radiographs. RESULTS: At the latest follow-up evaluation, all patients were pain free (including absence of snuffbox tenderness) except one who experienced slight discomfort during extreme activities. There was no statistically significant difference in the arc of motion between the surgically treated and healthy sides, and the average grip strength was 96% that of the contralateral extremity. Clinical and radiographic union was present in all cases at a mean of 3.4 months after surgery. The Modified Mayo Wrist score was excellent in 11 patients and good in 1. There were no complications. CONCLUSIONS: Open reduction and internal fixation with a Herbert screw reliably obtained union in all patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

Volar percutaneous cannulated screw fixation of acute scaphoid waist fractures reportedly produces high rates of healing and early return to work, but the method has not been reported for treating scaphoid waist delayed unions. We therefore report the surgical results of percutaneous screw fixation in scaphoid waist delayed union in 12 patients. All patients were male with an average age of 31.1 years. Duration of injury was 12 weeks (range, 6–20 weeks). However, no patient had carpal instability, scaphoid deformity, or avascular necrosis of the proximal fracture fragment. The minimal followup was 12 months (mean, 20 months; range, 12–24 months). Preoperative radiographs showed slight bone resorption at the fracture site in five patients and cyst formation in three patients. A cannulated screw was introduced volarly under image intensifier guidance in all patients. All fractures united uneventfully. At 12 month followups, the flexion and extension arcs of the injured wrist were 94% and 93% of the uninjured wrist. Grip strength averaged 34 ± 3 kg, which was 92% of the grip strength of the uninjured hand. The Mayo Modified Wrist Score was 94 ± 6 points and the Disabilities of the Arm, Shoulder, and Hand score was 9 ± 6 points. Our experience suggests volar percutaneous screw fixation is a reliable method to treat scaphoid waist delayed union.     

手术治疗舟骨骨折49例结果及体会

目的报道手术治疗49例舟骨骨折的结果及体会。方法经皮或切开复位Acutrak钉/空心钉/可吸收钉/U形钉内固定舟骨骨折,陈旧性骨折及骨坏死者加做带血管蒂桡骨茎突骨瓣移植,记录术后骨折愈合时间、握力、腕关节活动度、疼痛、恢复工作时间及腕关节功能评分。结果对本组患者进行随访1～8.5年,平均3.6年;骨折愈合时间为7～12周,平均10.8周。腕关节平均评分85.2分;功能优28例,良21例,差0例。所有患者均恢复原来的工作或改为较轻的工作。结论经皮或切开复位螺钉固定、带血管蒂桡骨茎突骨瓣移植是治疗舟骨骨折的一种好方法;骨折类型不同,手术方法也需有所变化。Acutrak钉固定效果好于空心钉或可吸收钉。短期随访,未见有桡骨茎突切除的并发症。桡腕关节桡侧切口有利于显露骨折端及骨瓣制备,值得推荐。带血管蒂桡骨茎突骨瓣移植可缩短骨折愈合时间。     

Surgical treatment of pediatric scaphoid fracture nonunions

Scaphoid fractures in the pediatric population are uncommon but can usually be successfully managed with standard immobilization techniques. However, nonunions of pediatric scaphoid wrist fractures have been reported. We present the treatment and outcome of 13 pediatric scaphoid fracture nonunions in 12 children treated over an 18-year period. The average time elapsed between time of fracture and time of surgery was 16.7 months. Four of the nonunions were treated by using the Matti-Russe procedure, and nine were treated with Herbert screw fixation and iliac crest bone grafting. The average time of follow-up was 6.9 years (range, 2-19 years). All cases went on to clinical and radiographic union. There was no statistically significant difference in range of motion or strength between the operative and nonoperative wrist. Eleven of 12 patients demonstrated an excellent rating based on the Mayo Modified Wrist score. The length of time for postoperative immobilization in the Herbert screw group was significantly less than that in the Matti-Russe group. Currently our standard approach to the treatment of scaphoid fracture nonunions in the skeletally immature patient is the use of the Herbert screw and iliac crest bone graft.