经皮舟骨固定术:不同方法的经验价值

Percutaneous Scaphoid Fixation: Experience Value among Different Approaches.

作者信息

Ramos-Marques Nuno, Ferrão Ana, Morais Bruno, Barreira Mariana, Teixeira Frederico

机构信息

Deparment of Orthopedic Surgery, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, EPE, Lisboa, Portugal.

出版信息

J Wrist Surg. 2021 Feb;10(1):23-26. doi: 10.1055/s-0040-1716352. Epub 2020 Sep 10.

Abstract

Percutaneous scaphoid osteosynthesis is an attractive and increasingly popular option, as a treatment for acute scaphoid fractures in selected cases, and as an alternative to conservative treatment. The purpose of this study is to assess the radiographic positioning of the screw in percutaneous scaphoid fixation, taking into consideration the surgeons' experience, and the difference between volar and dorsal approaches.  We retrospectively assessed patients undergoing percutaneous scaphoid fixation from 2013 to 2019. Inclusion criteria are as follows: (1) scaphoid waist fractures (Herbert's B2), (2) a minimum of 18 years of age and a maximum of 55 years of age, (3) dominant hand, (4) manual work, (5) minimum follow-up time of 6 months, and (6) without associated lesions. Criteria for correct positioning are as follows: (1) on the axis or parallel to the scaphoid axis with a maximum deviation of 1.5 mm volar/dorsal, (2) without proximal/dorsal prominence, (3) correct scaphoid alignment/reduction, and (4) absence of threads in the fracture site. Radiographs were evaluated separately by a hand surgeon, a general orthopaedic surgeon, and an orthopaedic resident.  With a total of 39 patients, a dorsal approach was performed in 10 patients and a palmar approach in 29 patients. We verified a very good interobserver reliability. The hand surgeon's team correctly positioned 15 (83.3%, 15/18), while the other team did 9 correctly (42.9%, 9/21). Comparing teams according to the approach used, the dorsal approach did not show a statistical difference, while the same was not true for the volar approach (  < 0.05).  This points to a positive impact on the team's experience in the positioning of the screws, and therefore in the benefit of treatment by teams dedicated to the area, while daring to suggest that less-experienced surgeons should utilize the dorsal approach.

摘要

经皮舟骨骨折内固定术是一种有吸引力且越来越受欢迎的选择,可用于特定病例的急性舟骨骨折治疗,也是保守治疗的替代方法。本研究的目的是评估经皮舟骨固定术中螺钉的放射学定位,同时考虑外科医生的经验以及掌侧和背侧入路之间的差异。

我们回顾性评估了2013年至2019年接受经皮舟骨固定术的患者。纳入标准如下:(1)舟骨腰部骨折(Herbert B2型);(2)年龄最小18岁,最大55岁;(3)优势手;(4)从事体力劳动;(5)最短随访时间6个月;(6)无相关损伤。正确定位标准如下:(1)位于舟骨轴线上或与舟骨轴线平行,掌侧/背侧最大偏差1.5毫米;(2)无近端/背侧突出;(3)舟骨对线/复位正确;(4)骨折部位无螺纹。由一名手外科医生、一名普通骨科医生和一名骨科住院医师分别对X线片进行评估。

总共39例患者,10例行背侧入路,29例行掌侧入路。我们验证了观察者间的可靠性非常好。手外科医生团队正确定位15例(83.3%,15/18),而另一团队正确定位9例(42.9%,9/21)。根据所使用的入路比较各团队,背侧入路未显示出统计学差异,而掌侧入路则不然(P<0.05)。

这表明团队经验对螺钉定位有积极影响,因此对专注于该领域的团队治疗有益,同时大胆建议经验不足的外科医生应采用背侧入路。

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