CAJ | 학술논문

目的：探讨Acutrak无头加压空心螺钉治疗舟骨骨折不愈合的早期疗效。方法：自2008年1月至2011年7月共收治21例舟骨骨折不愈合患者，男18例，女3例，平均年龄（23．6±4．6）岁。右侧12例，左侧9例。根据Herbert-Fisher分型：D1型10例，D2型7例，D3型3例，D4型1例。受伤至手术时间（12．4±2．7）个月。所有患者采用Acutrak无头加压空心螺钉固定，其中6例行2枚螺钉固定，15例行1枚螺钉固定；7例固定同时行Matti-Russe植骨。测量手术前后腕骨高度、舟骨指数及舟月角变化。记录腕关节活动范围及握力，并采用PRWE评分评定手术效果。结果：21例平均随访（21．3±3．6）个月。骨折均影像学愈合，平均愈合时间（13．3±2．4）周。无明显围手术期并发症发生。术后舟骨指数及舟月角分别为0．69±0．10和（44．3±8．2）°，较术前的0．61±0．13和（59．4±6．8）°明显改善（P＜0．05）。握力显著提高，疼痛明显缓解。术后PRWE评分高于术前（76．1±5．2 vs 45．2±4．7，P＜0．05）。21例术后均返回原工作岗位，平均时间（6．0±1．1）个月。结论：对于舟骨骨折不愈合，Acutrak无头加压空心螺钉固定能达到舟骨解剖复位，术后愈合率高，腕关节功能恢复较好，早期疗效满意。
목적：탐토Acutrak무두가압공심라정치료주골골절불유합적조기료효。방법：자2008년1월지2011년7월공수치21례주골골절불유합환자，남18례，녀3례，평균년령（23．6±4．6）세。우측12례，좌측9례。근거Herbert-Fisher분형：D1형10례，D2형7례，D3형3례，D4형1례。수상지수술시간（12．4±2．7）개월。소유환자채용Acutrak무두가압공심라정고정，기중6례행2매라정고정，15례행1매라정고정；7례고정동시행Matti-Russe식골。측량수술전후완골고도、주골지수급주월각변화。기록완관절활동범위급악력，병채용PRWE평분평정수술효과。결과：21례평균수방（21．3±3．6）개월。골절균영상학유합，평균유합시간（13．3±2．4）주。무명현위수술기병발증발생。술후주골지수급주월각분별위0．69±0．10화（44．3±8．2）°，교술전적0．61±0．13화（59．4±6．8）°명현개선（P＜0．05）。악력현저제고，동통명현완해。술후PRWE평분고우술전（76．1±5．2 vs 45．2±4．7，P＜0．05）。21례술후균반회원공작강위，평균시간（6．0±1．1）개월。결론：대우주골골절불유합，Acutrak무두가압공심라정고정능체도주골해부복위，술후유합솔고，완관절공능회복교호，조기료효만의。
Objective:To evaluate the early clinical and radiographic outcome of scaphoid non unions treated with Acu-trak headless compression screw. Methods:From January 2008 to July 2011,21 patients with scaphoid non union were treated in our department. There were 18 males and 3 females with a mean age of (23.6±4.6) years;12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification,there were 10 cases with type D1,7 cases with type D2,3 cases with type D3,and 1 case with type D4. The mean time from injury to operation was (12.4±2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation,15 cases received 1 screw fixation,and Matti-Russe bone grafting was applied in 7 cases). The carpal height,the scaphoid index and changes of the scapholunate an-gle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE). Results:Average duration of follow up was (21.3±3.6) months. All the patients attained radiological union in a mean time of (13.3±2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61±0.13 and the pre-operative mean scapholunate angle of (59.4±6.8)° to be improved to 0.69±0.10 and(44.3±8.2)° postoperatively,respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 ±4.7 was improved to 76.1 ±5.2 postoperatively. All patients returned back to the original work ,the average time from surgery to work was (6.0±1.1) months. Conclusion:For scaphoid non unions,Acutrak headless compression screw fixation can provide anatomical reduction,provide satisfactory results with a high union rate,well return of function and minimal complica-tions in the early stage.