应用改制加压螺钉内固定治疗陈旧性腕舟骨骨折

目的探讨普通螺钉简单改制成加压螺钉内固定治疗陈旧性腕舟骨骨折的临床疗效。方法1995年1月～2002年12月采用改制的加压螺钉内固定治疗陈旧性腕舟骨骨折25例,其中延迟愈合17例,骨不连接、假关节形成8例。将普通的皮质骨螺钉去掉部分螺纹后,使之变成具有加压作用的螺钉,通过简单的手术器械将其拧入复位后的舟骨内,对舟骨断端加压固定。结果19例获得随访,时间1～6年(平均3年),14例骨折愈合,平均愈合时间7个月,腕关节活动范围在106°～128°之间；3例未愈合,2例舟骨近端塌陷变形。结论改制加压螺钉治疗腕舟骨骨折具有对骨折端有加压作用、固定稳固、可经关节面置入、对关节干扰小、材料易取及操作简单等优点,是治疗陈旧性腕舟骨骨折的有效方法。

Treatment of old scaphoid fractures by internal fixation with modified common screws

Objective To introduce treatment of old scaphoid fractures by internal fixation with common screws which have been modified into compression-like ones.Methods Twenty-five patients with old scaphoid fracture were admitted to our department from January,1995 to December,2002.They were 17 cases of delayed union,and eight cases of non-union and pseudoarticulation formation.All the patients were treated with open re- duction anti internal fixation by modified common cortical bone screws,some threads of which bad been erased so that they could act somewhat like compression ones.The modified screws were driven into the reduced scaphoid by simple surgical instruments to fix and compress the fracture ends.Results Nineteen cases were followed up for one to six years (mean,3 years).Fourteen cases of fracture healed,with an average healing time of 7 months.The mean extension-flexion arc of the injured wrists was between 106 degrees and 128 degrees.Three cases failed to heal,and two cases experienced deformed and sunken proximal scaphoid.Conclusions Common cortical bone screws can be easily changed into compression-like ones to treat old scaphoid fractures and result in satisfactory,clinic outcome.In addition,they are easily available,can be inserted through joint facet with limited negative effect on the joint,and play a double role of compression and fixation.