Prabowo Kukuh Aji, Lopatta Eric, Lenz Mark, Friedel Reinhardt, Marintschev Ivan, Graul Isabel, Teichgräber Ulf
Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena.
Klinik für Diagnostische und Interventionelle Radiologie, Thüringen-Kliniken Georgius Agricola Saalfeld.
Handchir Mikrochir Plast Chir. 2021 Feb;53(1):47-54. doi: 10.1055/a-1276-1364. Epub 2021 Feb 15.
Incorrect screw placement and penetration in screw fixation of scaphoid fractures are found in 5 to 30 %. Therefore, optimizing of screw placement is desirable, especially because an exact central position of the screw in the proximal fragment leads to a significant higher stability as a more peripheral position.
36 patients with an acute non-displaced scaphoid fracture were included in this randomized prospective study. 18 patients underwent navigated, the other 18 conventional percutaneous screw fixation of an acute non-displaced scaphoid fracture through a dorsal approach. Operation time and x-ray dose were measured. In both groups the position of the screw in the scaphoid was calculated on CT scans and compared with each other. Clinically, 17 patients with navigated and 11 with conventional percutaneous screw fixation with an average age of 52 resp. 43.2 years were available for follow-up examination including Krimmer- and DASH-score.
All scaphoids healed within an adequate time. Two cases of navigated screw fixation have been converted to conventional percutaneous screw fixation. The average operation time in the navigated group was 83.2 minutes, in the conventional group 42.1 minutes. X-ray dose measured 106,5 ± 19,9cGy/cm in the navigated group and 45,6 ± 8,0cGy/cm in the conventional group. Screw penetration using an intraosseous compression screw (HSC) was observed in 5 conventionally fixed scaphoids, 4 distally (2,27 ± 1,47 mm), 1 proximally. In the navigated group there were 11 screw penetrations, 4 proximally (2,01 ± 0,81 mm) and distally (1,21 ± 0,64 mm), 3 distally (1,18 ± 0,44 mm), and 4 proximally (1,61 ± 0,57 mm). Axial screw position was more accurate in the conventional group. The 17 navigated patients averaged a Krimmer-Score of 83.6 and a DASH-score of 5,6 points at follow-up. The 11 conventional treated patients averaged a Krimmer-Score of 95 and a DASH-score of 8.0 points at follow-up.
In this study navigated screw fixation of acute non-displaced scaphoid fractures was not superior to conventional percutaneous screw fixation, neither for screw position, screw penetration nor with respect to the clinical outcome.
在舟骨骨折的螺钉固定中，螺钉放置错误和穿透的发生率为5%至30%。因此，优化螺钉放置是可取的，特别是因为螺钉在近端骨折块中的精确中心位置比更周边的位置能带来显著更高的稳定性。
本随机前瞻性研究纳入了36例急性无移位舟骨骨折患者。18例患者接受了导航下急性无移位舟骨骨折经背侧入路的经皮螺钉固定，另外18例接受了传统经皮螺钉固定。测量了手术时间和X线剂量。在两组中，通过CT扫描计算舟骨内螺钉的位置并进行相互比较。临床上，17例接受导航下固定和11例接受传统经皮螺钉固定的患者可进行随访检查，平均年龄分别为52岁和43.2岁，随访检查包括Krimmer评分和DASH评分。
所有舟骨均在适当时间内愈合。2例导航下螺钉固定转为传统经皮螺钉固定。导航组的平均手术时间为83.2分钟，传统组为42.1分钟。导航组的X线剂量为106.5±19.9cGy/cm，传统组为45.6±8.0cGy/cm。在5例传统固定的舟骨中观察到使用骨内加压螺钉（HSC）导致的螺钉穿透，4例在远端（2.27±1.47mm），1例在近端。在导航组中，有11例螺钉穿透，4例在近端（2.01±0.81mm），4例在远端（1.21±0.64mm），3例在远端（1.18±0.44mm），4例在近端（1.61±0.57mm）。传统组的轴向螺钉位置更准确。17例接受导航下固定的患者在随访时Krimmer评分平均为83.6分，DASH评分为5.6分。11例接受传统治疗的患者在随访时Krimmer评分平均为95分，DASH评分为8.0分。
在本研究中，急性无移位舟骨骨折的导航下螺钉固定在螺钉位置、螺钉穿透或临床结果方面均不优于传统经皮螺钉固定。
