CAJ | 학술논문

目的：探讨CT引导下经皮穿刺复位Herbert螺钉治疗腕舟骨骨折的疗效。方法2010年9月～2012年10月对21例腕舟骨骨折在CT引导下完成Herbert螺钉内固定。疗效评定包括骨折愈合、疼痛、握力和腕关节活动度，采用腕关节功能评分标准对患者自觉恢复情况进行评定。结果手术时间25～55 min，平均35．3 min；术中出血量8～40 ml，平均18．6 ml。骨折断端均获得骨性愈合，平均愈合时间10．4周（8～17周）。21例随访8～13个月，平均9．8月，末次随访：VAS评分（1．2±0．8）分，显著低于术前（5．3±1．4）分（t＝11．785，P＝0．000）；握力（39．6±3．5）kg，显著高于术前（19．4±2．4）kg （t＝-21．624，P＝0．000）；腕关节屈伸角度115．3°±7．4°，显著高于术前89．8°±10．4°（t＝-9．103，P＝0．000）；腕关节尺桡偏角度53．7°±5．5°，显著高于术前39．4°±3．4°（t ＝-10．116，P＝0．000）；腕关节功能优18例，良3例，优良率100％。结论在CT引导下经皮穿刺复位Herbert螺钉微创治疗腕舟骨骨折疗效满意。
목적：탐토CT인도하경피천자복위Herbert라정치료완주골골절적료효。방법2010년9월～2012년10월대21례완주골골절재CT인도하완성Herbert라정내고정。료효평정포괄골절유합、동통、악력화완관절활동도，채용완관절공능평분표준대환자자각회복정황진행평정。결과수술시간25～55 min，평균35．3 min；술중출혈량8～40 ml，평균18．6 ml。골절단단균획득골성유합，평균유합시간10．4주（8～17주）。21례수방8～13개월，평균9．8월，말차수방：VAS평분（1．2±0．8）분，현저저우술전（5．3±1．4）분（t＝11．785，P＝0．000）；악력（39．6±3．5）kg，현저고우술전（19．4±2．4）kg （t＝-21．624，P＝0．000）；완관절굴신각도115．3°±7．4°，현저고우술전89．8°±10．4°（t＝-9．103，P＝0．000）；완관절척뇨편각도53．7°±5．5°，현저고우술전39．4°±3．4°（t ＝-10．116，P＝0．000）；완관절공능우18례，량3례，우량솔100％。결론재CT인도하경피천자복위Herbert라정미창치료완주골골절료효만의。
Objective To investigate therapeutic effects of CT-guided percutaneous minimally invasive treatment by using Herbert screws for wrist scaphoid fracture . Methods From September 2010 to October 2012, 21 patients with scaphoid fracture were treated by internal fixation by using Herbert screws under the guidance of CT .The results of the procedure were assessed in terms of osseous union , pain extent , grip strength , and active motion of the wrist .Postoperative outcomes were evaluated by wrist standard scores based on patients’ perception of functions. Results The operation time was 25 -55 min (mean, 35.3 min).The intraoperative blood loss was 8-40 ml (mean, 18.6 ml).Fracture fragments were cured with bone union , with an average healing time of 10.4 weeks (range, 8-17 weeks).All the 21 cases were followed up for 8 -13 months (mean, 9.8 months).The VAS scores at the last follow-up was (1.2 ±0.8) points, which was significantly lower than that before the operation (5.3 ±1.4) points (t=11.785, P=0.000).The grip strength was (39.6 ±3.5) kg, which was significantly higher than that preoperatively [(19.4 ± 2.4) kg, t=-21.624, P =0.000].The Angle of wrist flexion and extension was 115.2°±7.4°, significantly higher than preoperative measure (89.8°±10.4°, t =-9.103, P =0.000).The wrist ulnar radial deflection angle was 53.7°±5.5°, significantly higher than preoperative one (39.4°±3.4°, t =-10.116, P=0.000).At the last follow-up assessment of wrist functions, excellent result was recorded in 18 cases, and good in 3 cases, with a good-or-excellent rate of 100%. Conclusion Treatment of scaphoid fracture with Herbert screws under the guidance of CT is a minimally invasive method , bearing advantages of little incision, simple operation performance , and good effects .