摘要目的 探讨不带血供的自体髂骨瓣移植交叉克氏针联合支具固定治疗青壮年舟骨腰部骨折骨不连的疗效.方法 自2010年1月至2015年8月,我们共收治18例舟骨腰部骨折骨不连患者.术前MRI检查评估均未伴舟骨近、远极缺血坏死.采用腕关节桡背侧切开,舟骨骨不连死骨清除,自体髂骨瓣移植填塞,交叉克氏针联合支具固定治疗.术后支具持续固定6周,随访观察,摄腕关节X线正侧位片,骨折线模糊后拔除克氏针.指导患者逐渐加强腕关节功能锻炼.结果 术后随访时间为6～24个月,平均13个月.所有舟骨腰部骨不连均愈合,其中2例延迟愈合,无并发舟骨坏死,腕关节稳定,16例腕关节疼痛消失,2例诉腕关节稍有疼痛不适,较术前明显缓解.术后腕关节背伸38°～60°(平均52°),腕关节掌屈36°～60°(平均48°),腕关节活动度明显改善.男性患者手握力为42.5 ～55.5 kg(平均50.6 kg),女性患者手握力为28.5～35.4 kg(平均32.6 kg),腕关节握力增加,均恢复原有工作.结论 对于舟骨腰部骨折骨不连青壮年患者,采用不带血供的自体髂骨瓣移植交叉克氏针联合支具固定治疗,操作简单,腕关节局部损伤较小,疗效满意.

abstractsObjective To explore the autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation in the treatment of scaphoid waist fracture nonunion in young adults.Methods From January 2010 and August 2015, 18 cases of scaphoid waist fracture nonunion were treated in our department.According to preoperative MRI evaluation, ischemic necrosis of proximal or distal pole scaphoid was not seen.The incision was made at dorsal radial wrist.Autologous iliac flap grafting and packing combined with cross Kirschner wire and splint fixation were conducted after cleaning up the dead bone of scaphoid nonunion.Postoperatively, injured limb was continuously fixed by splint for 6 weeks.Removal of Kirschner wire was conducted when fracture line blurred showed by wrist X-ray photograph.The patients were guided to gradually strengthen the wrist joint function exercise.Results Postoperative follow-up ranged from 6 to 24 months, with an average of 13 months.All the cases of scaphoid waist fracture nonunion were healed with 2 cases of delayed union.No scaphoid necrosis occurred.Wrist joint stability was achieved.Wrist joint pain disappeared in 16 cases.Two cases still had slightly pain and significantly alleviated compared with preoperative condition.Postoperatively the angle of wrist extension was 38° to 60° (average, 52°), of wrist flexion 36° to 60° (average, 48°).The wrist range of motion obviously improved.Hand grip strength was 42.5 to 55.5 kg (average, 50.6 kg) for male patients and 28.5 to 35.4 kg (average, 32.6 kg) for female patients.Grip strength increased postoperatively and the patients returned to original work.Conclusion Autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation is a good method for treating scaphoid waist fracture nonunion in young adults, because of the simple technique, minor local injuries of wrist, and satisfactory curative effects.