摘要目的 探讨采用带锁H型钛板行腕骨间四角融合联合舟骨切除治疗腕塌陷的临床疗效.方法 自2010年5月至2015年6月,我们采用带锁H型钛板行头、月、三角及钩骨四角融合并舟骨切除术治疗12例腕塌陷患者.腕塌陷原因:陈旧性舟骨骨折不愈合6例,陈旧性经舟骨月骨周围脱位5例,舟骨月骨进行性腕塌陷1例.根据术后患手使用情况、腕关节活动度、握力、静息和用力后腕关节疼痛程度等方面对手术疗效进行评价.结果 术后随访时间为8～37个月,平均22个月,术后患手平均握力为(33.5±6.5) kg,恢复至健侧的79％;腕关节活动范围达到健侧的50％以上,患腕关节疼痛明显缓解,未出现骨不连及伤口感染等并发症.结论应用带锁H型钛板行头、月、三角及钩骨四角融合固定可靠,融合率高,能够保存大部分腕关节功能,是治疗腕塌陷的有效办法.

abstractsObjective To investigate the clinical efficacy of four-comer arthrodesis with H type titanium plate combined with scaphoid resection in the treatment of carpal collapse.Methods From May 2010 to June 2015,12 patients with carpal collapse were treated by four-corner arthrodesis of capitate,lunate,triquetrum and hamate with H type titanium plate combined with scaphoid resection.The causes of carpal collapse included nonunion old scaphoid fracture in 6 cases,old trans-scaphoid perilunar dislocation in 5 cases and scapholunate advanced collapse in 1 case.The clinical efficacy evaluation included hand using condition,wrist movement,hand grip strength,the degree of wrist pain after resting or exerting force.Results The follow-up time ranged from 8 to 37 months with an average of 22 months.The postoperative hand grip strength averaged (33.5±6.5) kg (79％ of the healthy side).The range of the wrist movement reached more than 50％ of the healthy side.The wrist pain relieved obviously,and no complications such as bone nonunion and wound infection occurred.Conclusion The application of four-comer arthrodesis of capitate,lunate,triquetrum and hamate with H type titanium plate can save most of the wrist joint function with reliable fixation and high rate of fusion,which is an effective method for the treatment of carpal collapse.