摘要
目的研究降低腕舟骨骨折临床误诊率和晚期骨不连发生率的有效措施，并筛选规范的治疗方法。方法对５９例舟骨骨折采用Ｘ线片、ＣＴ、３ＤＣＴ和ＭＲＩ等手段进行早、晚期诊断。采用并比较保守治疗、克氏针交叉固定、游离植骨加克氏针固定、骨间前动脉背侧支为血管蒂的逆行桡骨瓣植入、加压螺栓内固定或加楔形植骨术、舟骨近端坏死骨片切除加掌长肌腱球植入、近排腕骨切除术和桡腕关节融合术等８种治疗方法的疗效和适应证。结果临床确诊率为１００％。保守治疗８例中４例未愈而改用手术治疗。手术治疗５５例全部骨性愈合，但４例遗有舟骨短缩和背凸畸形。结论采用四种体位摄影并作两侧对比的Ｘ线片，确诊率不低于９５％。ＣＴ、ＭＲＩ是对早、晚期诊断有决定意义的检查方法。加压螺栓内固定对腕舟骨早、晚期骨折及背凸畸形的疗效优于其它方法。
Objective To investigate the effective method to reduce the erronous diagnostic rate and incidence of non union of the carpal scaphoid fractures(CSF), and choose the standard management. Methods 59 cases of CSF were diagnosed by X ray examinations,CT,MRI, arthrography and isotopic scanning of the wrist, and were treated by 8 methods, namely, non operation, cross Kirschner wire fixation ,free bone grafting with Kirschner wire fixation ,vascularized radial bone grafting based on the dorsal branch of anterior interosseous artery, Herbert's screw fixation with or without wedge bone grafting, osteotomy of necrosed proximal scaphoid and tendon bulb embedding, proximal carpectomy, and radiocarpal fusion. The treatment outcome and the indications of these procedures were compared. Results Clinical correct diagnostic rate of CSF was 100%. In 8 cases of conservative treatment, non union were found in 4. All 55 cases receiving surgical treatment got osseous union, but 4 cases had shortening and DISI deformities. Conclusions 4 position X ray examinations combined with bilateral comparison achieved 95% diagnostic rate for scaphoid fracture . CT and MRI played a critical role in diagnosing the fracture in early and late stage. Herbert's screw fixation was superior to other procedures .
出处
《中华手外科杂志》
CSCD
1998年第3期144-146,共3页
Chinese Journal of Hand Surgery
关键词
腕舟骨骨折
诊断
显微外科手术
治疗
Carpal bone Fracture Diagnosis Microsurgery Treatment outcome
