Hopital Universitaire de Bicetre, AP-HP, Bicetre F-94270, Univ Paris-Sud, Department of Orthopaedic Surgery, 78 rue du General Leclerc, 94270 Le Kremlin-Bicetre, France.
Injury. 2009 Jun;40(6):645-51. doi: 10.1016/j.injury.2009.01.131. Epub 2009 Apr 21.
Volar percutaneous screw fixation (PSF) of acute nondisplaced scaphoid waist fractures allows early mobilisation of the wrist and a faster return to work than prolonged cast immobilisation. Usually, placement of the wire which guides the definitive canulated screw is performed by hand. Nevertheless, correct placement of this wire is technically difficult. We designed a guidewire insertion device (GID) to facilitate this placement.
We compared the hand held technique with the technique using the GID in a cadaveric study. The hand held technique was performed on 16 scaphoids and the GID was used in 16 other scaphoids. The four participating surgeons were divided into two groups: two experienced surgeons and two inexperienced surgeons.
The GID significantly decreased procedure duration (P<0.001), number of attempts to place the wire (P<0.001), and number of image-intensifier shots (P<0.001). With both techniques, experienced surgeons were significantly faster (P=0.0083) and required significantly fewer attempts (P=0.043) than inexperienced surgeons. Using the GID, the procedure duration (P=0.0039) and the number of image-intensifier shots (P<0.001) decreased more with inexperienced surgeons than with experienced surgeons. As for the number of attempts, there was no statistical difference between the two groups (P=0.32).
The GID decreased the time and radiation exposure needed to achieve correct volar percutaneous wire placement in the scaphoid, compared to the conventional hand held technique. Easier wire placement may lead surgeons to use PSF instead of prolonged cast immobilisation for treating nondisplaced scaphoid fractures.
经掌侧皮穿刺螺钉固定（PSF）治疗急性无移位舟状骨腰部骨折，可使腕关节早期活动，比长时间石膏固定更快地恢复工作。通常，引导最终可通螺钉的导丝是通过手来放置的。然而，正确放置这条导丝在技术上具有挑战性。我们设计了一种导丝插入装置（GID）来辅助导丝的放置。
我们在尸体研究中比较了手持技术和使用 GID 的技术。手持技术在 16 个舟状骨上进行，GID 则用于另外 16 个舟状骨。四名参与的外科医生分为两组：两名经验丰富的外科医生和两名经验不足的外科医生。
GID 显著缩短了手术时间（P<0.001）、导丝放置尝试次数（P<0.001）和影像增强器拍摄次数（P<0.001）。使用两种技术时，经验丰富的外科医生明显更快（P=0.0083），并且需要的尝试次数明显更少（P=0.043）。与经验丰富的外科医生相比，使用 GID 时，经验不足的外科医生的手术时间（P=0.0039）和影像增强器拍摄次数（P<0.001）减少得更多。至于尝试次数，两组之间没有统计学差异（P=0.32）。
与传统的手持技术相比，GID 可减少经掌侧皮穿刺正确放置舟状骨导丝所需的时间和辐射暴露。更简单的导丝放置可能会促使外科医生选择 PSF 而不是长时间石膏固定来治疗无移位的舟状骨骨折。
