中国修复重建外科杂志

中国修复重建外科杂志

超声引导下经皮 Herbert 螺钉治疗新鲜无移位腕舟骨骨折

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目的 观察超声引导下经皮 Herbert 螺钉固定治疗新鲜无移位腕舟骨骨折的临床疗效。 方法 2013 年 5 月—2015 年 8 月,采用超声引导下经皮 Herbert 螺钉固定治疗新鲜 Krimmer 分型 A2 型腕舟骨骨折 15 例。其中男 12 例,女 3 例;年龄 18~51 岁,平均 33.4 岁。致伤原因:摔伤 9 例,训练伤 3 例,机器伤 3 例。受伤至手术时间 2~15 d,平均 5 d。无其他合并症。记录手术时间、术中出血量、术中透视次数、骨折愈合情况,腕关节功能采用改良 Mayo 腕关节评分标准进行评定。 结果 患者手术时间 28~53 min,平均 33.9 min;术中出血量 5~30 mL,平均 10.5 mL;术中透视次数 2~6 次,平均 2.6 次。15 例均获随访,随访时间 6~18 个月,平均 10.5 个月。1 例患者出现钉道入口皮肤处疼痛、酸胀感,经熏洗后逐渐缓解;无感染等并发症发生。骨折均获骨性愈合,愈合时间 8~16 周,平均 11.6 周。末次随访时改良 Mayo 腕关节评分为 76~99 分,平均 92.5 分;获优 12 例,良 2 例,可 1 例,优良率 93.3%。 结论 超声引导下经皮 Herbert 螺钉固定治疗新鲜 Krimmer 分型 A2 型腕舟骨骨折出血少,医患放射损害小,是一种可行的方法。

Objective To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Methods Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. Results The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Conclusion Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.

关键词: 腕舟骨骨折; 经皮固定; 超声

Key words: Carpal scaphoid fractures; percutaneous fixation; ultrasonography

引用本文: 王孝辉, 王庆丰, 张彩丽, 沈素红, 李无阴. 超声引导下经皮 Herbert 螺钉治疗新鲜无移位腕舟骨骨折. 中国修复重建外科杂志, 2018, 32(8): 989-992. doi: 10.7507/1002-1892.201802023 复制

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