带蒂桡骨膜移位螺钉内固定治疗陈旧性腕舟骨骨折

目的介绍一种较有效的治疗陈旧性腕舟骨骨折的手术. 方法 1995年4月～2002年4月,采用桡动脉茎突返支为蒂的骨膜移位螺钉内固定,必要时加桡骨茎突切除治疗陈旧性腕舟骨骨折11例,男8例,女3例,年龄17～46岁.其中舟骨腰部骨折7例,近端骨折2例,远端骨折2例;X线片示骨折线分离小于1 mm 4例,大于1 mm 3例,骨端硬化2例,囊性变2例. 结果术后随访3～24个月,9例术后2～4个月内骨愈合,2例分别于术后6～7个月骨愈合.骨折愈合后3个月取内固定,腕关节疼痛、无力等症状均消失. 结论术式操作简便,血供可靠,成骨力强,骨折愈合时间短,腕关节功能恢复满意.

TREATMENT OF OLD SCAPHOID FRACTURE WITH TRANSPOSITION OF VASCULARIZED PERIOSTEAL FLAP AND INTERNAL FIXATION

Objective To introduce an effective method of treating old scaphoid fracture. Methods From April 1995 to April 2002,11 patients with old scaphoid fracture were treated with transposition of vascularized periosteal flap and internal fixation; if necessary, the radial styloid was removed. Out of 11 patients( 8 males and 3 females, aged from 17 to 46 years), the fracture sites were medial scaphoid in 7, the proximal one in 2 and the distal one in 2. The X ray films showed separated fracture lines. The fracture lines were less than 1 mm in 4 patients and more than 1 mm in 3 patients. Sclerosis of skeleton ends and cystoid degeneration occurred in 2 patients, respectively. Results After a follow up of 3 to 24 months, the fracture healing was obtained within 4 months in 9 cases and within 6 to 7 months in 2 cases. Internal fixation was taken out 3 months after bone healing. The carpal joint pain and weakness vanished in all cases. Conclusion Transposition of vascularized periosteal flap and internal fixation have many advantages, such as easy dissection, rich blood supply, quick new bone formation, short time of fracture healing and satisfactory function recovery of carpal joint.