短臂管型石膏固定治疗陈旧腕舟骨骨折18例临床报告

目的:观察采用不固定所有掌指关节的聚氨酯短臂管型石膏外固定治疗陈旧腕舟骨骨折的疗效。方法:自1999年8月至2008年1月在本所就诊的18例陈旧腕舟骨骨折患者,受伤至开始石膏固定平均6.3个月(2~12个月),其中2例断端部分硬化,另2例舟骨近侧骨折块有缺血坏死改变。采用聚氨酯短臂管型石膏固定腕关节,固定范围从肘前横纹下5cm到手掌横纹,腕关节固定于10°背伸、20°尺偏位置,所有掌指关节都不固定。每1至2个月检查石膏固定情况并复查X线片,石膏若有松动及时更换。结果:16例经X线片证实获得骨折愈合(88.9%),平均固定4.7个月(3~8个月),其中2例舟骨近侧骨折块缺血坏死患者,其达到骨折愈合的固定时间分别是5个月和6个月。2例骨折未愈合:其中1例为骨折断端有部分硬化,固定5个月无愈合迹象;另1例固定2个月后未愈合,患者放弃治疗。骨折愈合的16例中,14例在去除石膏后随访平均9.3个月(2~24个月),有4例腕背伸受限约10°,3例诉腕活动时轻微疼痛,其余患者腕关节活动范围无受限,无疼痛。结论:陈旧腕舟骨骨折伤后1年内,骨折断端无明显硬化者,多数可以采用不固定所有掌指关节的聚氨酯短臂管型石膏固定治愈;陈旧腕舟骨骨折近端骨折块发生缺血坏死者,虽然石膏固定治疗所需时间较长,但仍有愈合可能。

Treatment of the Delayed/Nonunion of Scaphoid Fracture by Short-arm Cast Immobilization Leaving All the Metacarpophalangeal Joint Free

Objective To study the clinical results of the short-arm cast immobilization leaving all the metacarpophalangeal joints free in the management of the delayed/nonunion of scaphoid fracture. Methods From August 1999 to January 2008, 18 cases of delayed/nonunion of scaphoid fracture were studied, including 2 cases with avascular necrosis in the proximal fragment and 2 cases with partial sclerosis. The average time from the injury was 6.3 months (range 2～12 months). The wrist was immobilized with a short-arm cast (from 5 cm below the elbow to the middle palmar crease), leaving all the metacarpophalangeal joints free until the fracture showed radiological signs of union. The wrist was fixed in 10 degrees of dorsiflexion and 20 degrees of ulnar deviation. All cases were reviewed every one or two months, and the cast should be changed if loose. Union of fracture was determined by plain radiograph. Results Union rate confirmed by plain radiograph was 88.9%(16 of 18) and average duration of cast was 4.7 months (range 3～8 months). Two cases with avascular necrosis in the proximal fragment achieved union after 5 and 6 months immobilization respectively. Of two failure cases of nonunion, one with partial sclerosis was immobilized for 5 months without signs of union and the other abandoned treatment after 2 months immobilization. Fourteen of the sixteen healed cases were followed up(with average of 9.3 months )after cast removal. Four cases were reported of 10 degrees dorsiflexion limitation of the wrist and three cases complained of mild pain during movement. Conclusion The delayed/nonunion of scaphoid fracture within 1 year after injury and without obvious sclerosis could achieve union with the short-arm cast immobilization leaving all the metacarpophalangeal joints free. The delayed/nonunion of scaphoid fracture with avascular necrosis in the proximal fragment need long term immobilization and also had chance of union.