[1]穆卫庐,常军英,贾东昭,等.Herbert螺钉微创掌侧入路和背侧入路治疗Herbert Ⅰb型腕舟骨骨折远期临床疗效及预后比较[J].新乡医学院学报,2021,38(12):1166-1170.[doi:10.7683/xxyxyxb.2021.12.012]
　MU Weilu,CHANG Junying,JIA Dongzhao,et al.Comparison of long-term clinical efficacy and prognosis of patients with Herbert type Ⅰb carpal scaphoid fractures treated by Herbert screw minimally invasive volar approach and dorsal approach[J].Journal of Xinxiang Medical University,2021,38(12):1166-1170.[doi:10.7683/xxyxyxb.2021.12.012]
点击复制

Herbert螺钉微创掌侧入路和背侧入路治疗Herbert Ⅰb型腕舟骨骨折远期临床疗效及预后比较
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年12
页码:
1166-1170
栏目:
临床研究
出版日期:
2021-12-05

文章信息/Info

Title:
Comparison of long-term clinical efficacy and prognosis of patients with Herbert type Ⅰb carpal scaphoid fractures treated by Herbert screw minimally invasive volar approach and dorsal approach
作者:
穆卫庐; 常军英; 贾东昭; 付　强; 冯建书; 侯卫星; 王彦志; 李　炎; 邢兆国; 李琦军
（石家庄市第三医院创伤骨科，河北　石家庄　050011）
Author(s):
MU Weilu; CHANG Junying; JIA Dongzhao; FU Qiang; FENG Jianshu; HOU Weixing; WANG Yanzhi; LI Yan; XING Zhaoguo; LI Qijun
(Department of Traumatology and Orthopedics,the Third Hospital of Shijiazhuang,Shijiazhuang 050011,Hebei Province,China)
关键词:
腕舟骨骨折; Herbert Ⅰb型; Herbert螺钉; 掌侧入路; 远期疗效
Keywords:
carpal scaphoid fracture; Herbert type Ⅰb; Herbert screw; volar approach; long-term efficacy
分类号:
R658.2
DOI:
10.7683/xxyxyxb.2021.12.012
文献标志码:
A
摘要:
目的　比较Herbert螺钉微创掌侧入路和背侧入路治疗Herbert Ⅰb型腕舟骨骨折患者的远期临床疗效及预后。 方法　选择2014年1月至2016年3月石家庄市第三医院收治的37例Herbert Ⅰb型腕舟骨骨折患者为研究对象，按随机数字表法分为掌侧组（n=19）和背侧组（n=18）。掌侧组患者采用掌侧经皮Herbert螺钉微创治疗,背侧组患者采用背侧经皮Herbert螺钉微创治疗。评估2组患者手术后3 a的临床疗效，并计算临床疗效优良率。采用改良Mayo 腕关节功能评分法评估2组患者手术前及手术后3 a的腕关节功能。采用角度计测量2组患者手术前及手术后3 a的腕关节活动情况，包括腕关节掌屈、背伸、桡偏、尺偏活动角度。记录2组患者腕骨骨折愈合时间、手术结束至重返工作岗位时间。手术后随访3 a，观察并记录随访期间2组患者并发症发生情况。 结果　手术后3 a，背侧组患者临床疗效优良率为88.89%(16/18)，掌侧组患者临床疗效优良率为94.74%(18/19)，2组患者临床疗效优良率比较差异无统计学意义(χ2=0.424，P>0.05)。2组患者手术后3 a的疼痛程度、功能状态、活动范围、握力及总评分均显著高于术前(P<0.05)；手术前、手术后3 a，掌侧组患者疼痛程度、功能状态、活动范围、握力及总评分与背侧组比较差异均无统计学意义(P>0.05)。2组患者手术后3 a的腕关节掌屈、背伸、桡偏、尺偏活动范围均显著高于术前 (P<0.05)；手术前、手术后3 a，掌侧组患者腕关节掌屈、背伸、桡偏、尺偏活动范围与背侧组比较差异均无统计学意义(P>0.05)。掌侧组患者骨折愈合时间和手术后至重返工作岗位时间均显著低于背侧组 (P<0.05)。随访期间，2组患者均未发生感染、骨不连、舟骨坏死、神经损伤、螺钉松动等并发症，仅背侧组中有1例患者出现轻度疼痛症状，活动受限，但握力良好，经辅助治疗腕关节功能恢复良好。 结论　掌侧经皮Herbert螺钉微创与背侧经皮Herbert螺钉微创治疗Herbert Ⅰb型腕舟骨骨折远期临床疗效相当，掌侧经皮Herbert螺钉微创治疗Herbert Ⅰb型腕舟骨骨折可加快骨折愈合时间，利于患者早日返回工作岗位。
Abstract:
Objective　Comparison of the long-term clinical efficacy and prognosis of patients with Herbert type Ⅰb carpal Scaphoid fractures treated by Herbert screw minimally invasive volar approach and dorsal approach.Methods　A total of 37 patients with Herbert type Ib carpal scaphoid fracture admitted to the Third Hospital of Shijiazhuang from January 2014 to March 2016 were selected as the research objects,and they were divided into volar group (n=19) and dorsal group (n=18) according to the random number table method.The patients in the volar group received minimally invasive treatment with volar percutaneous Herbert screws,and the patients in the dorsal group received minimally invasive treatment with dorsal percutaneous Herbert screws.Three years after operatien,the clinical efficacy of patients in the two groups was evaluated,and the rate of excellent and good of clinical efficacy was calculated.The wrist function of patients before and three years after operation in the two groups was evaluated by the modified Mayo wrist function scoring method.The wrist joint activities including wrist flexion,back extension,radial deviation and ulnar deviation of patients before and three years after the operation in the two groups were measured by the goniometers.The time of carpal fracture healing and the time from the end of operation to returning to work of patients in the two groups were recorded.The postoperative follow-up was conducted for three years,and the complications of patients in the two groups during the follow-up period were observed and recorded.Results　Three years after operation,the excellent and good rate of clinical efficacy of patients in the dorsal group was 88.89%(16/18),and the excellent and good rate of patients in the volar group was 94.74%(18/19).There was no significant difference in the excellent and good rate of clinical efficacy of patients between the two groups (χ2=0.424,P>0.05).The pain degree,functional status,range of motion,grip strength and total scores of patients in the two groups three years after operation were significantly higher than those before operative (P<0.05);there was no significant difference in the pain degree,functional status,range of motion,grip strength and total scores of patients before and three years after operation between the volar group and the dorsal group (P>0.05).The range of wrist joint motion of palmar flexion,back extension,radial deviation and ulnar deviation of patients in the two groups three years after operation were significantly higher than those before operation (P<0.05);there was no significant difference in the range of wrist joint motion of palmar flexion,back extension,radial deviation and ulnar deviation of patients before and three years after operation between the volar group and the dorsal group (P>0.05).The time of fracture healing and the time from the end of operation to returning to work of patients in the volar group were significantly shorter than those in the dorsal group (P<0.05).During the follow-up period,none of the patients in the two groups had complications such as infection,nonunion,scaphoid necrosis,nerve damage,screw loosening;only one patient in the dorsal group had mild pain symptoms,limited mobility,but good grip strength,the wrist joint function finally recovered well after treatment.Conclusion　There is no significant difference in long-term clinical efficacy between volar percutaneous Herbert screw minimally invasive and dorsal percutaneous Herbert screw minimally invasive in treatment of Herbert type Ⅰb carpal scaphoid fracture,the volar percutaneous Herbert screw minimally invasive in treatment of Herbert type Ⅰb carpal scaphoid fracture can speed up fracture healing time and help patients return to work as soon as possible.

参考文献/References:

［1］　魏利成,雷光华,易汉文,等.腕关节镜监视经皮螺钉内固定治疗新鲜腕舟骨骨折的初步临床疗效研究［J］.中国内镜杂志,2016,22(2):57-60.
［2］　WALLNER J,REINBACHER K,FEICHTINGER M,et al.Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment:a new approach［J］.J Craniomaxillofac Surg,2017,45(4):526-539.
［3］　KOTRASHETTI S M,SINGH A G.Prospective study of treatment outcomes with lag screw versus Herbert screw fixation in mandibular fractures［J］.Int J Oral Maxillofac Surg,2017,46(1):54-58.
［4］　王培吉.新鲜腕舟骨骨折治疗方法的选择［J］.中华手外科杂志,2016,32(2):83.
［5］　路来金.亟待提高腕舟骨骨折的整体诊治水平［J］.中华手外科杂志,2016,32(2):81.
［6］　吴伟,刘晓峰,严松鹤,等.掌侧经皮Herbert螺钉微创治疗腕舟骨骨折11例报告［J］.中国微创外科杂志,2017,17(6):538-541.
［7］　曾俊,林旭,钟泽莅,等.个体化经皮空心螺钉内固定治疗Herbert Ⅰb型腕舟骨骨折的临床研究［J］.中国修复重建外科杂志,2016,30(10):1189-1194.
［8］　RUBY G,NINA S,MACDERMID J C.Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union［J］.Open Orthop J,2016,10(1):431-438.
［9］　BYOUNG J K,DAVID K,YOUNG M L,et al.The role of lunate morphology on scapholunate instability and fracture location in patients treated for scaphoid nonunion［J］.Clin Orthop Surg,2016,8(2):175-176.
［10］　何信坤,陈宏,王欣,等.开放手术及关节镜微创术式治疗腕舟骨骨折不连接的临床研究［J］.中华手外科杂志,2018,34(4):247.
［11］　MANDALESON A,THAM S K,LEWIS C,et al.Scaphoid fracture fixation in a nonunion model:a biomechanical study comparing 3 types of fixation［J］.J Hand Surg Am,2018,43(3):69-70.
［12］　滕晓峰,陈宏,王欣,等.腕关节镜辅助下经皮克氏针固定治疗腕舟骨新鲜骨折［J］.中华创伤杂志,2018,34(9):773.
［13］　ZHANG X,WEI Q,JI F,et al.Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation［J］.Zhongguo Gu Shang,2018,31(5):441-445.
［14］　MAHMOUD M,HEGAZY M,KHALED S A,et al.Radiographic parameters to predict union after volar percutaneous fixation of Herbert type b1 and b2 scaphoid fractures［J］.J Hand Surg Am,2016,41(2):203-207.
［15］　MEIER R,PANZICA M.First results with a resorbable MgYREZr compression screw in unstable scaphoid fractures show extensive bone cysts［J］.Handchir Mikrochir Plast Chir,2017,49(1):37-41.
［16］　滕晓峰,袁辉宗,陈宏.腕关节镜治疗舟骨骨折不愈合进行性塌陷的效果［J］.中华创伤杂志,2018,34(9):787.
［17］　VARGA P,ZYSSET P,SCHEFZIG P,et al.A finite element analysis of two novel screw designs for scaphoid waist fractures［J］.Med Eng Phys,2016,38(2):131-139.
［18］　梁高峰,智丰,石宇,等.桡骨远端骨折合并舟骨骨折的手术治疗［J］.中华手外科杂志,2016,32(2):90.
［19］　蒋继乐,刘波,陈山林,等.掌、背侧入路经皮加压螺钉内固定治疗急性舟骨腰部骨折［J］.中华骨科杂志,2016,36(14):898.
［20］　EL-MAHALLAW Y,AL-MAHALAWY H.Herbert cannulated bone screw osteosynthesis in anterior mandibular fracture treatment:a comparative study with lag screw and miniplate［J］.J Oral Maxillofac Surg,2018,76(6):127-128.
［21］　熊文,潘昊,郑琼.Herbert钉在足舟状骨骨折治疗中的应用［J］.重庆医学,2017,46(5):53-55.
［22］　张鹏,董启榕,王宗允,等.内、外侧双切口结合Herbert螺钉内固定治疗合并同侧踝关节骨折的Hawkins Ⅲ型距骨颈骨折［J］.中华医学杂志,2016,96(41):3342.
［23］　SULTAN A,KHURSHEED O,BHAT M R,et al.Management of capitellar fractures with open reduction and internal fixation using Herbert screws［J］.Ulus Travma Acil Cerrahi Derg,2017,23(6):507-514.
［24］　王戌佳,邵钦,杨晨松,等.Herbert螺钉治疗MasonⅡ型桡骨头骨折［J］.中华手外科杂志,2018,34(2):100.
［25］　徐辉豪,黄俊伍.Herbert螺钉内固定和石膏外固定治疗腕舟骨稳定型骨折的比较研究［J］.中华手外科杂志,2016,32(2):85.

更新日期/Last Update: 2021-12-05