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如何减轻腕骨的固定?24例采用1.5毫米无头加压螺钉治疗的病例。

How to ease the fixation of carpal bones? Twenty-four lesions treated by 1,5 mm headless compression screws.

作者信息

Poggetti Andrea, Suardi Chiara, Lauri Giulio, Espen David, Bigazzi Prospero, Pfanner Sandra

机构信息

Hand and Reconstructive Microsurgery Unit, A.O.U.C, Florence, IT, Italy.

Hand Team Unit, Marienklinik, Bolzen, IT, Italy.

出版信息

J Clin Orthop Trauma. 2021 Apr 20;18:56-60. doi: 10.1016/j.jcot.2021.03.022. eCollection 2021 Jul.

Abstract

BACKGROUND

Carpal bone lesions are common, even in acute injuries or as sequalae of missed fractures. If not correctly diagnosed and treated, can lead to loss of function, especially in active patients. The surgical management remain difficult particularly in case of small, atypical or non-unions fragments. The treatment of heterogenic shape fractures should require a fragment specific fixation using, traditionally, Kirschner-wire (K-wire). This method of treatment remains the most popular but could be prone to some complication as: not stable fixation, need to long time immobilization and wire mobilization. Nineteen patients presented with carpal bone lesions were treated by the use of HCS 1,5 mm headless compression screws. Patients were evaluated post-operative by Patient-Rated Wrist Evaluation (PRWE), the Visual Analogic Scale (VAS), Quick-DASH Score and the grip strength was measured by Jamar dynamometer.

RESULTS

Authors observed improvement of pain control and common activity; fine movements were restored; we observed no post-operative functional instability.

CONCLUSIONS

HCS 1,5 mm headless compression screws are suitable and smart technique to treat these uncommon fractures to achieve a stable primary fixation and allow an early mobilization and conciliate the versatility of K-wire and the compression action due to screws also in small bone fragment.

摘要

背景

腕骨损伤很常见,即使在急性损伤或漏诊骨折的后遗症中也是如此。如果没有正确诊断和治疗,可能会导致功能丧失,尤其是在活跃的患者中。手术治疗仍然很困难,特别是在小的、非典型的或不愈合碎片的情况下。对于形状各异的骨折,传统上应使用克氏针(K 线)进行特定碎片的固定。这种治疗方法仍然是最常用的,但可能容易出现一些并发症,如固定不稳定、需要长时间固定和钢丝松动。19 例腕骨损伤患者使用 1.5 毫米无头加压螺钉进行治疗。术后通过患者自评腕关节评估(PRWE)、视觉模拟量表(VAS)、快速 DASH 评分进行评估,并使用 Jamar 测力计测量握力。

结果

作者观察到疼痛控制和日常活动有所改善;精细运动得以恢复;我们未观察到术后功能不稳定。

结论

1.5 毫米无头加压螺钉是治疗这些罕见骨折的合适且巧妙的技术,可实现稳定的一期固定,并允许早期活动,兼顾了克氏针的多功能性以及螺钉在小骨碎片中的加压作用。

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