CAJ | 학술논문

目的通过对临床和影像学结果进行直线相关性分析研究,探讨影响双头空心加压螺钉治疗舟骨骨折术后功能恢复的因素.方法 2007年12月至2012年8月,应用3.0 mm AO双头空心加压螺钉治疗舟骨骨折20例.男12例,女8例;年龄15 ～ 55岁,平均32.7岁.按照AO分型:B1型8例,B2型10例,C2型1例,C3型1例.随访内容包括腕关节功能客观指标:主动活动度(active range of motion,AROM)、前臂旋转活动度、握力、捏力;影像学指标:腕高比(carpal height ratio,CHR)、舟月骨间角(scapholunate angle,SLA)、螺钉与舟骨长轴之间的夹角、螺钉与骨折线之间的夹角.对随访数据进行直线相关性分析,比较腕关节功能客观指标与影像学指标之间的相关性.结果随访时间10～ 44个月,平均21.7个月.通过对腕关节功能客观指标和影像学指标进行直线相关性分析,发现在所测量值范围内握力和螺钉与舟骨长轴之间的夹角呈正相关关系(P=0.04,r=0.47);旋后和舟月骨间角呈正相关关系(P=0.04,r=0.45);前臂旋前和腕高比呈负相关关系(P=0.01,r=-0.54).结论在本研究测量值范围内,握力和螺钉与舟骨长轴之间的夹角、旋后活动度和舟月骨间角呈正比;前臂旋前活动度和腕高比呈反比.结合研究结果,建议在临床应用双头空心加压螺钉治疗舟骨骨折时应尽量把螺钉放置在舟骨的居中位置,同时注意舟月骨间角、腕骨高度的恢复.
목적 통과대림상화영상학결과진행직선상관성분석연구,탐토영향쌍두공심가압라정치료주골골절술후공능회복적인소.방법 2007년12월지2012년8월,응용3.0 mm AO쌍두공심가압라정치료주골골절20례.남12례,녀8례;년령15 ～ 55세,평균32.7세.안조AO분형:B1형8례,B2형10례,C2형1례,C3형1례.수방내용포괄완관절공능객관지표:주동활동도(active range of motion,AROM)、전비선전활동도、악력、날력;영상학지표:완고비(carpal height ratio,CHR)、주월골간각(scapholunate angle,SLA)、라정여주골장축지간적협각、라정여골절선지간적협각.대수방수거진행직선상관성분석,비교완관절공능객관지표여영상학지표지간적상관성.결과 수방시간10～ 44개월,평균21.7개월.통과대완관절공능객관지표화영상학지표진행직선상관성분석,발현재소측량치범위내악력화라정여주골장축지간적협각정정상관관계(P=0.04,r=0.47);선후화주월골간각정정상관관계(P=0.04,r=0.45);전비선전화완고비정부상관관계(P=0.01,r=-0.54).결론 재본연구측량치범위내,악력화라정여주골장축지간적협각、선후활동도화주월골간각정정비;전비선전활동도화완고비정반비.결합연구결과,건의재림상응용쌍두공심가압라정치료주골골절시응진량파라정방치재주골적거중위치,동시주의주월골간각、완골고도적회복.
Objective To investigate factors that influence functional recovery after surgical treatment of scaphoid fractures with double-headed cannulated compression screw through linear correlation analysis of clinical and radiographic outcomes.Methods From December 2007 to August 2012,20 scaphoid fractures were treated with open reduction and internal fixation with 3.0 mm AO cannulated compression screws.There were 12 males and 8 females.The average age was 32.7 years,ranging from 15 to 55 years.According to AO classification,there were 8 cases of type B1,10 cases of type B2,1 case of type C2 and 1 case of type C3 fractures.Postoperative follow-up evaluations included both objective wrist function indicators including active range of motion of wrist and forearm rotation,grip strength,pinch strength; and radiographic parameters including carpal height ratio (CHR),scapholunate angle (SLA),the angle between screw and the longitudinal axis of the scaphoid,and the angle between the screw and the fracture line.Correlation between the objective data and the radiographic parameters were analyzed.Results Follow-up time ranged from 10 to 44 months,with an average of 21.7 months.There were positive correlations between grip strength and the angle between the screw and the longitudinal axis of the scaphoid (P =0.04,r =0.47),and between supination and SLA (P =0.04,r =0.45).There was a negative correlation between pronation and CHR (P =0.01,r =-0.54).Conclusion Within the scope of our measured values,grip strength and supination were positively proportionate to the angle between the screw and the longitudinal axis of the scaphoid and to SLA,respectively; while pronation was inversely proportionate to CHR.Based on our results we recommend placing the double-headed cannulated compression screw centrally in the scaphoid when fixing scaphoid fractures and paying attention to restoring SLA and CHR.