中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
2期
183-188
,共6页
张颖%路来金%宫旭%崔建礼%孙希光%蒋子平%余欣
張穎%路來金%宮旭%崔建禮%孫希光%蔣子平%餘訢
장영%로래금%궁욱%최건례%손희광%장자평%여흔
舟骨%月骨%骨折%脱位%内固定器
舟骨%月骨%骨摺%脫位%內固定器
주골%월골%골절%탈위%내고정기
Scaphoid bone%Lunate bone%Fractures,bone%Dislocations%Internal Fixators
目的 探讨舟骨、月骨骨折和(或)脱位的诊断和治疗效果.方法 收集2005年1月至2013年12月收治并获得随访的舟骨、月骨骨折和(或)脱位患者的病历资料,按照纳入及排除标准共77例患者纳入研究进行回顾性分析.男64例,女13例;年龄15～73岁,平均31.9岁.单纯骨折41例,骨折合并脱位32例,单纯脱位4例.按治疗方式分为保守治疗组(9例)和手术治疗组(68例),手术治疗组再依术式(加压螺钉固定术、克氏针固定术、近排腕骨切除术和月骨切除+头状骨移位术)分为4个亚组.术后1、3、6、12个月及超过24个月进行的末次随访进行疗效评价,临床评估采用改良Mayo腕功能评分,影像学评估采用腕关节正、侧位X线片观察骨折愈合情况及腕关节稳定性.结果 77例患者均获得随访,随访时间6个月～8年,平均3年5个月.保守治疗的9例患者中4例骨折未愈合再次行手术治疗并纳入手术治疗组.手术治疗组中加压螺钉固定36例、克氏针固定34例、近排腕骨切除1例、月骨切除+头状骨移位1例.加压螺钉组骨折愈合时间平均为6.1周,克氏针固定组为7周.根据改良Mayo腕功能评价标准,优51例(66.2％)、良11例(14.3％)、可9例、差6例,优良率为80.5％.加压螺钉固定组治愈率为97％,克氏针固定组治愈率为85％,两组治愈率的差异有统计学意义.术后舟骨骨折畸形愈合4例,畸形程度不重且仅1例背曲畸形的患者为优势手,经对症处理后腕痛症状消失.1例舟骨陈旧性骨折合并经舟骨、月骨周围性脱位患者术后出现腕关节不稳定,18周后行桡、舟、头韧带紧缩术,再次术后Mayo评分为优.结论 腕关节正、侧位X线片是舟骨、月骨骨折和(或)脱位的常用检查方法,但易误诊、漏诊,须加摄特殊体位.治疗应以手术为主,宜根据骨折和(或)脱位的具体情况选择相应术式,加压螺钉固定术的治疗效果优势较明显.
目的 探討舟骨、月骨骨摺和(或)脫位的診斷和治療效果.方法 收集2005年1月至2013年12月收治併穫得隨訪的舟骨、月骨骨摺和(或)脫位患者的病歷資料,按照納入及排除標準共77例患者納入研究進行迴顧性分析.男64例,女13例;年齡15～73歲,平均31.9歲.單純骨摺41例,骨摺閤併脫位32例,單純脫位4例.按治療方式分為保守治療組(9例)和手術治療組(68例),手術治療組再依術式(加壓螺釘固定術、剋氏針固定術、近排腕骨切除術和月骨切除+頭狀骨移位術)分為4箇亞組.術後1、3、6、12箇月及超過24箇月進行的末次隨訪進行療效評價,臨床評估採用改良Mayo腕功能評分,影像學評估採用腕關節正、側位X線片觀察骨摺愈閤情況及腕關節穩定性.結果 77例患者均穫得隨訪,隨訪時間6箇月～8年,平均3年5箇月.保守治療的9例患者中4例骨摺未愈閤再次行手術治療併納入手術治療組.手術治療組中加壓螺釘固定36例、剋氏針固定34例、近排腕骨切除1例、月骨切除+頭狀骨移位1例.加壓螺釘組骨摺愈閤時間平均為6.1週,剋氏針固定組為7週.根據改良Mayo腕功能評價標準,優51例(66.2％)、良11例(14.3％)、可9例、差6例,優良率為80.5％.加壓螺釘固定組治愈率為97％,剋氏針固定組治愈率為85％,兩組治愈率的差異有統計學意義.術後舟骨骨摺畸形愈閤4例,畸形程度不重且僅1例揹麯畸形的患者為優勢手,經對癥處理後腕痛癥狀消失.1例舟骨陳舊性骨摺閤併經舟骨、月骨週圍性脫位患者術後齣現腕關節不穩定,18週後行橈、舟、頭韌帶緊縮術,再次術後Mayo評分為優.結論 腕關節正、側位X線片是舟骨、月骨骨摺和(或)脫位的常用檢查方法,但易誤診、漏診,鬚加攝特殊體位.治療應以手術為主,宜根據骨摺和(或)脫位的具體情況選擇相應術式,加壓螺釘固定術的治療效果優勢較明顯.
목적 탐토주골、월골골절화(혹)탈위적진단화치료효과.방법 수집2005년1월지2013년12월수치병획득수방적주골、월골골절화(혹)탈위환자적병력자료,안조납입급배제표준공77례환자납입연구진행회고성분석.남64례,녀13례;년령15～73세,평균31.9세.단순골절41례,골절합병탈위32례,단순탈위4례.안치료방식분위보수치료조(9례)화수술치료조(68례),수술치료조재의술식(가압라정고정술、극씨침고정술、근배완골절제술화월골절제+두상골이위술)분위4개아조.술후1、3、6、12개월급초과24개월진행적말차수방진행료효평개,림상평고채용개량Mayo완공능평분,영상학평고채용완관절정、측위X선편관찰골절유합정황급완관절은정성.결과 77례환자균획득수방,수방시간6개월～8년,평균3년5개월.보수치료적9례환자중4례골절미유합재차행수술치료병납입수술치료조.수술치료조중가압라정고정36례、극씨침고정34례、근배완골절제1례、월골절제+두상골이위1례.가압라정조골절유합시간평균위6.1주,극씨침고정조위7주.근거개량Mayo완공능평개표준,우51례(66.2％)、량11례(14.3％)、가9례、차6례,우량솔위80.5％.가압라정고정조치유솔위97％,극씨침고정조치유솔위85％,량조치유솔적차이유통계학의의.술후주골골절기형유합4례,기형정도불중차부1례배곡기형적환자위우세수,경대증처리후완통증상소실.1례주골진구성골절합병경주골、월골주위성탈위환자술후출현완관절불은정,18주후행뇨、주、두인대긴축술,재차술후Mayo평분위우.결론 완관절정、측위X선편시주골、월골골절화(혹)탈위적상용검사방법,단역오진、루진,수가섭특수체위.치료응이수술위주,의근거골절화(혹)탈위적구체정황선택상응술식,가압라정고정술적치료효과우세교명현.
Objective To analysis the clinical diagnosis and treatment of the scaphoid and lunate bone fracture with (or) wrist dislocation.Methods A retrospective analysis of the clinical data included 77 cases,which got admitted according to the inclusion and exclusion criteria and followed up completely from 2005 to 2013.In this group,there were 64 males and 13 females whose age arranged from 15 to 73 with a mean age of 31.9.There were 41 cases of simple fracture,32 cases of bone fracture with dislocation and 4 cases of simple dislocation.Treatment of cases was divided into the conservative treatment group (9 cases) and the surgery group (68 cases).The surgery group was further divided into four subgroups according to surgical method (i.e.compression screw fixation,Kirschner wire fixation,proximal row of carpal resection,and lunate excision head shaped bone transposition).Clinical outcome was evaluated based on modified Mayo wrist score and X-ray.Results All of 77 patients were followed up completely.Follow-up time arranged from 6 months to 8 years,with an average follow-up time of 3 years and 5 months.9 cases were treated conservatively.In the surgical treatment group,there were 36 cases of compression screw fixation,34 cases of Kirschner wire fixation,1 case of proximal row of carpal resection and 1 case of the lunate bone resection heads transposition.The average healing time of compression screw group was 6.1 weeks and the Kirschner group was 7 weeks.According to the modified Mayo wrist score,excellent:51 cases (66.2％),good:11 cases (14.3％),fair:9 cases,and poor:6 cases.The rate of excellent and good was 80.5％.The cure rate of compression screw treatment was 97％,and 85％ of Kirschner.The difference of cure rate was statistically significant.After surgery,there were four cases that got scaphoid malunion.The degree of deformity was not serious with only one case happened in the dominant hand,and the wrist pain got better after symptomatic treatment.1 case of scaphoid fracture with dislocation had the problem of wrist instability.18 weeks later,with ligament tightening surgery,postoperative Mayo score went back to excellent.Conclusion Lateral X-ray film of wrist is a preferred method for the examination of scaphoid and lunate fractures with (or) dislocation.Since it's easy to misdiagnose,films of special position are needed to be added.Surgery is preferred for treatment,and the selecting of surgical methods are based on the situation of fracture and dislocation.The advantages of screw fixation are obvious.
