经皮腕背入路DTJ空心螺钉内固定治疗舟骨骨折

目的 总结经皮腕背人路DTJ空心螺钉内固定治疗舟骨骨折的经验.方法 利用经皮腕背人路DTJ空心螺钉内固定治疗舟骨骨折患者12例,男10例,女2例;年龄16~39岁,平均25岁.根据改良Herbert舟骨骨折分型:A2型3例,82型5例,83型2例,D1型2例.10例新鲜骨折患者自受伤至就诊时间为1~12d,平均3.5d;2例纤维愈合患者自受伤至就诊时间分别为76d和68d.结果 骨愈合时间为术后6.5~9.5周,平均8.5周.除1例患者行体力劳动后自觉有轻度腕痛外,其余11例患者术后疼痛均消失.患者均获得随访,随访时间6~26个月,平均14个月.12例患者术后患手握力恢复至健侧的平均86.4%(82%~93%),患侧腕关节屈伸活动度恢复至健侧的平均87.5%(83%~100%).除1例患者体力劳动后自觉有轻度腕痛改变原工作外,6例患者于术后平均5.5周(4.5~8周)返回原工作岗位,5例学生患者于术后平均4.5个月(3~6个月)恢复体育运动.所有患者腕背小切口均一期愈合,无感染等并发症发生.结论 经皮腕背入路DTJ空心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的有效治疗方法.

Percutaneous fixation of scaphoid fractures with DTJ cannulated screws via a dorsal approach

Objective To summarize the experience of percutaneous fixation of scaphoid fractures with DTJ cannulated screws via a dorsal approach, and provide a reliable and efficient treatment method for scaphoid fractures. Methods 12 patients with scaphoid fractures were treated surgically by percutaneous fixation with DTJ cannulated screws via a dorsal approach, including 10 men and 2 women with an average age of 25 years. Among them, 3 cases were identified as type A2,5 as B2,2 as B3,and 2 as D1, according to the modified Herbert classification. Durations from injury to operation ranged from 1 to 12 days with an average of 3.5 days in acute cases, and were 76 days and 68 days in 2 D1 cases. The follow-up period were from 6 months to 20 months averaging with 14 months. Results All the patients achieved bone union at mean 8.5 weeks (range, 6.5 to 9.5 weeks) postoperatively. Pain relief was obtained in all cases except one mild wrist pain only after labor work. The grip strength and ROM (range of motion) returned to 86.4% (range, 82% to 93%) and 87.5% (range, 83% to 100%), compared with the healthy sides respectively. Only 1 patient had to change his job after operation due to the mild wrist pain. 6 patients returned to their previous working position at mean 5.5 weeks postoperatively, and 5 patients re-exercised at mean 4.5 months postoperatively. No operation complications such as infection occurred. Conclusion Percutaneous fixation with DTJ cannulated screws via a dorsal approach is a reliable and efficient treatment method for scaphoid fractures with mini-invasion, high bone union rate, and less complications.