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手法整复石膏外固定治疗经舟状骨骨折月骨周围脱位
Hits: 1829   Download times: 1254   Received:February 20, 2018    
作者Author单位UnitE-Mail
张欣 ZHANG Xin 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
魏强 WEI Qiang 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning yesterdaywei@126.com 
纪方 JI Fang 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
佟大可 TONG Da-ke 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
唐昊 TANG Hao 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
章浩 ZHANG Hao 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
于金国 YU Jin-guo 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
杨继东 YANG Ji-dong 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
崔睿 CUI Rui 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
霍宁宁 HUO Ning-ning 上海长海医院创伤骨科, 上海 200433 Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation ZHANG Xin, WEI Qiang, JI Fang, TONG Da-ke, TANG Hao, ZHANG Hao, YU Jin-guo, YANG Ji-dong, CUI Rui, and HUO Ning-ning  
期刊信息:《中国骨伤》2018年31卷,第5期,第441-445页
DOI:10.3969/j.issn.1003-0034.2018.05.009


目的:探讨手法整复石膏外固定治疗经舟状骨骨折月骨周围脱位的疗效及并发症。

方法:回顾性分析自2009年1月至2013年1月期间经舟状骨骨折月骨周围脱位患者43例,其中17例(男10例,女7例)采取手法整复、石膏外固定治疗,为保守组;26例(男15例,女11例)采取手术治疗,为手术组。通过腕关节功能评分、影像学评价、并发症分析等方式评价疗效。

结果:43例患者获随访,时间36~60(45.00±8.72)个月。末次随访Cooney腕关节功能评分:保守组88.53±4.24,手术组89.58±4.59(t=0.455,P>0.05)。随访期内保守组4例患者出现舟状骨缺血性坏死的影像学表现(χ2=4.32,P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。

结论:对于经舟状骨骨折月骨周围脱位患者,若能够在伤后尽早进行手法整复、石膏外固定,并维持满意的复位与可靠的固定,则治疗效果与手术治疗相比没有劣势,但有增加并发症的危险。保守治疗的关键在于尽可能早期诊断并维持复位,可靠的固定,以及适时、恰当的功能锻炼。
[关键词]:舟骨  骨折  月骨  脱位  骨折闭合复位  外固定器
 
Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation
Abstract:

Objective: To investigate the efficacy and complications of manual reduction and external fixation for the treatment of scaphoid fractures and perilunate dislocations.

Methods: From January 2009 to January 2013, 43 patients suffered from scaphoid fractures and perilunate dislocations were retrospective analyzed. Among them, 17 cases were treated with manipulative reduction and plaster external fixation as conservation group including 10 males and 7 females, the other 26 cases were treated with application of surgical as operation group including 15 males and 11 females. The clinical effects were assessed by Cooney function score, radiological analysis and observation of complications.

Results: All patients were followed up for (45.00±8.72) months ranging from 36 to 60 months. At the final follow-up, the Cooney score of wrist function was 88.53±4.24 in conservation group and 89.58±4.59in operation group (t=0.455, P>0.05). During the follow-up, 4 patients were found scaphoid avascular necrosis in the imaging performance in the conservation group (χ2=4.32, P<0.05). The difference of other complications between two groups was not statistically significant (P>0.05).

Conclusion: For patients suffered from the scaphoid fractures and perilunate dislocation, the early manipulative reduction and plaster external fixation after injury as soon as possible is necessary. Maintaining a satisfactory reduction and reliable fixation at the same time can lead to good treatment effect and there's no weakness compared to surgical treatment. But there was an increase in danger of complications. The key of conservative treatment lies in early diagnosis and maintenance of reduction, reliable fixation, and timely and appropriate functional exercise.
KEYWORDS:Scaphoid bone  Fractures  Lunate bone  Dislocations  Closed fracture reduction  External fixators
 
引用本文,请按以下格式著录参考文献:
中文格式:张欣,魏强,纪方,佟大可,唐昊,章浩,于金国,杨继东,崔睿,霍宁宁.手法整复石膏外固定治疗经舟状骨骨折月骨周围脱位[J].中国骨伤,2018,31(5):441~445
英文格式:ZHANG Xin,WEI Qiang,JI Fang,TONG Da-ke,TANG Hao,ZHANG Hao,YU Jin-guo,YANG Ji-dong,CUI Rui,HUO Ning-ning.Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(5):441~445
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