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.

TREATMENT OF OLD SCAPHOID FRACTURE WITH ABSORBABLE SCREW

OBJECTIVE: To explore a new approach to treat old scaphoid fracture by grafting bones from distal radius and fixing absorbable screws. METHODS: From January 2002 to May 2007, 18 patients with old scaphoid fractures were treated by grafting bones from distal radius and fixing absorbable screws. All of the 18 patients (13 males and 5 females, aged from 17 to 41 years old) had the injury history of the palm of hand touching the ground. They felt tenderness on the anatomical snuff-box and tubercle of scaphoid bone. The grasping force decreased. The range of motion of the wrist was (36 +/- 2) degrees extension/(30 +/- 3) degrees flexion, (8 +/- 3) degrees radialis/(13 +/- 2) degrees ulnaris. RESULTS: The average postoperative follow-up period was 15.7 months. A total of 18 cases achieved bone union. The range of motion of the wrist in the 16 healed cases was (68 +/- 2) degrees extension/(65 +/- 3) degrees flexion, (15 +/- 3) degrees radialis/(28 +/- 5) degrees ulnaris. There was no pain of motion and symptom of powerlessness. As to the other 2 cases, the range of motion of the wrist was (40 +/- 8) degrees extension/(35 +/- 6) degrees flexion, (8 +/- 5) degrees radialis/(12 +/- 5) degrees ulnaris; no obvious improvement was found; the patients occasionally felt painful in daily life; the extension force decreased. No infection and break of internal fixation were seen. CONCLUSION: The absorbable screw as a new biomaterial for internal fixation has obvious advantages of good biocompatibility, promoting union of the fracture and no need of a second operation for removal.