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目的 探讨腕舟状骨骨折微创手术治疗的临床疗效.方法 在C臂机透视下,采用掌侧或背侧入路经皮或小切口导针指引置入AO空心加压螺钉或Herbert钉治疗舟状骨骨折患者19例,根据Herbert分型:A2型2例,B1型3例,B2型9例,B3型4例,C型1例.经掌侧入路9例,背侧入路10例.结果 术后随访6～18个月,所有病例骨折均愈合,愈合时间6～12周,平均9.5周.腕关节功能采用改良Mayo评分:优6例,良11例,可2例.腕关节平均活动度为伸腕68°(55°～ 85°)、屈腕57°(45°～ 75°),患者均恢复工作,2例在重体力活动中有轻度腕关节疼痛,其中1例因螺钉头穿出舟骨远极皮质约2 mm,腕关节极度桡偏活动时可诱发疼痛.结论 AO空心加压螺钉或Herbert钉微创治疗舟状骨骨折固定牢靠,疗效确切.

Objective To evaluate the clinical outcomes of minimally invasive operation for the treatment of scaphoid fractures.Methods Under C arm fluoroscopy, 19 cases of scaphoid fractures were treated with AO compressed hollow screws or Herbert screws introduced through a percutaneous or small incision guide via the volar or dorsal approach.According to Herbert' s classification, there were 2 cases of type A2 fractures, 3 cases of type B1, 9 cases of type B2, 4 cases of type B3,and 1 case of type C fracture.Volar approach was used in 9 cases, while dorsal approach in 10 cases.Results All the cases were follow-up for 6 to 18 months postoperatively.All the fractures healed.The time of fracture healing was 6 to 12 weeks, with an average of 9.5 weeks.Based on the modified Mayo scoring system, the wrist ftmction was rated as excellent in 6 cases, good in 11 cases, and fair in 2 cases.The mean extension of the wrist was 68° (range, 55° to 85°), while the mean flexion of the wrist was 57° (range, 45° to 75°).All patients had returned to work, with only mild wrist pain in 2 cases during heavy physical activities.In 1 case where the screw head was 2 mm out of the scaphoid far pole cortex, pain could be evoked during extreme radial deviation of the wrist.Conclusion AO compressed hollow screws or Herbert screws can achieve minimally invasive fixation of scaphoid fractures with reliable fixation and satisfactory results.