Minimally invasive treatment of acute scaphoid fracture with titanium hollow compression screw

doi:10.3969/j.issn.2095-4344.1946

Abstract

Abstract:

BACKGROUND: Surgery is one of the main methods for the treatment of acute scaphoid fracture. But it is still controversial whether percutaneous titanium hollow compression screw internal fixation is reliable for the treatment of non-displaced or slightly displaced scaphoid fractures.

OBJECTIVE: To retrospectively analyze the efficacy of closed reduction and percutaneous hollow compression screw internal fixation in the treatment of scaphoid fractures.

METHODS: Twenty-one patients with scaphoid fractures who received closed reduction and percutaneous hollow compression screw internal fixation surgery in the Department of Traumatology and Orthopedics, Peking University People’s Hospital, China between January 2010 and July 2018 were included in this study. All of them underwent preoperative X-ray and CT examination to make diagnosis and clarify classification. They were followed up for over 3 months. Postoperative X-ray examination was also performed to identify fracture healing. Modified Mayo wrist function score was used to evaluate postoperative efficacy.

RESULTS AND CONCLUSION: Scaphoid fractures healed successfully in all patients, with an average healing time of (9.10±3.03) weeks. The average time for patients to resume daily work or study was (7.00±4.08) days. According to the modified Mayo clinic score, excellent healing was found in 16 patients, good healing in 4 patients, and fair healing in 1 patient, with the excellent and good rate of 95.2%. Patients with Herbert type B1 (n=6) had lower postoperative Mayo pain score than those with A2 (n=5) and B2 (n=10) (P < 0.05). This indicates that patients with B1 type had more postoperative pain. Results from this study suggest that closed reduction percutaneous titanium hollow compression screw internal fixation surgery is reliable in the treatment of acute scaphoid fracture. This study was approved by Medical Ethics Committee, Peking University People’s Hospital, China.

Key words: scaphoid bone, fracture, acute, displacement, minimally invasive, surgery, hollow compression screw, Herbert classification, Mayo scales, retrospective study

CLC Number:

R459.9','1');return false;" target="_blank">
R459.9

R605

R683

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Han Quan, Xiong Jian, Wang Yanhua, Dang Yu, Zhang Peixun, Fu Zhongguo, Zhang Dianying, Wang Tianbing. Minimally invasive treatment of acute scaphoid fracture with titanium hollow compression screw[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(34): 5413-5417.

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URL: https://www.cjter.com/EN/10.3969/j.issn.2095-4344.1946

https://www.cjter.com/EN/Y2019/V23/I34/5413

Figures/Tables 5

2.1 受试者数量分析纳入急性腕舟骨骨折接受经皮钛质空心加压螺钉内固定治疗患者21例，均完成术前评估、术后X射线评估及随访，无中途退出及失访病例，最终计入结果分析患者21例。见图1。"

2.2 患者基线信息  患者21例基线资料见表2。根据Herbert分型，该组病例中A2型5例(23.8%)，B1型6例(28.6%)，B2型10例(47.6%)。所有16例B型(B1和B2)骨折患者中，7例(43.8%)存在断端移位，最大移位不超过    2.0 mm，9例(56.2%)断端无移位。"

2.3 随访结果所有21例患者均成功接受微创手术治疗，术后随访时间均大于3个月。术后未出现切口感染、切口愈合不良、血管神经损害等不良反应，至随访时，骨折均愈合，未见腕舟骨坏死。平均骨折愈合时间(9.10±3.03)周(5-16周)。除外2例腰椎骨折患者，余19例患者恢复日常工作或学习的平均时间为(7.00±4.08) d (2-15 d)。根据改良Mayo评分，16例为优，4例为良，1例一般，优良率达95.2%。此外，B1型患者较A2和B2患者术后疼痛程度更重(P < 0.05)，在工作情况、活动范围及握力等方面，3组间无显著性差异。见表3。"

2.4 典型病例  患者，女，20岁，因“摔伤后左腕肿胀疼痛3 d”于2016-12-09入院。入院前完善腕关节正侧位及CT考虑诊断左腕舟骨骨折。于2016-12-12行臂丛神经阻滞麻醉下左腕舟骨骨折经皮钛质空心加压螺钉内固定治疗，术中置入型号3.0 mm×24.0 mm加压螺钉，术中透视见内固定满意。术后伤口愈合良好，无感染、血管神经损伤等并发症，术后3 d返校。术后6周复查腕关节正侧位示腕舟骨骨折愈合，术后1年随访，患者腕关节无疼痛，活动范围及握力较对侧无减退，对日常学习及工作无影响。见图2。"

2.5 不良反应分析  患者21例术后均未发生不良反应，见表4。"

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Minimally invasive treatment of acute scaphoid fracture with titanium hollow compression screw

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[1]	Xu Feng, Kang Hui, Wei Tanjun, Xi Jintao. Biomechanical analysis of different fixation methods of pedicle screws for thoracolumbar fracture [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1313-1317.
[2]	Zhang Chong, Liu Zhiang, Yao Shuaihui, Gao Junsheng, Jiang Yan, Zhang Lu. Safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1381-1386.
[3]	Yao Rubin, Wang Shiyong, Yang Kaishun. Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1387-1392.
[4]	Chen Xinmin, Li Wenbiao, Xiong Kaikai, Xiong Xiaoyan, Zheng Liqin, Li Musheng, Zheng Yongze, Lin Ziling. Type A3.3 femoral intertrochanteric fracture with augmented proximal femoral nail anti-rotation in the elderly: finite element analysis of the optimal amount of bone cement [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1404-1409.
[5]	Du Xiupeng, Yang Zhaohui. Effect of degree of initial deformity of impacted femoral neck fractures under 65 years of age on femoral neck shortening [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1410-1416.
[6]	Zhang Chao, Lü Xin. Heterotopic ossification after acetabular fracture fixation: risk factors, prevention and treatment progress [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1434-1439.
[7]	Zhou Jihui, Li Xinzhi, Zhou You, Huang Wei, Chen Wenyao. Multiple problems in the selection of implants for patellar fracture [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1440-1445.
[8]	Wang Debin, Bi Zhenggang. Related problems in anatomy mechanics, injury characteristics, fixed repair and three-dimensional technology application for olecranon fracture-dislocations [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1446-1451.
[9]	Chen Jinping, Li Kui, Chen Qian, Guo Haoran, Zhang Yingbo, Wei Peng. Meta-analysis of the efficacy and safety of tranexamic acid in open spinal surgery [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1458-1464.
[10]	Hu Kai, Qiao Xiaohong, Zhang Yonghong, Wang Dong, Qin Sihe. Treatment of displaced intra-articular calcaneal fractures with cannulated screws and plates: a meta-analysis of 15 randomized controlled trials [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1465-1470.
[11]	He Li, Tian Wei, Xu Song, Zhao Xiaoyu, Miao Jun, Jia Jian. Factors influencing the efficacy of lumbopelvic internal fixation in the treatment of traumatic spinopelvic dissociation [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 884-889.
[12]	Yang Weiqiang, Ding Tong, Yang Weike, Jiang Zhengang. Combined variable stress plate internal fixation affects changes of bone histiocyte function and bone mineral density at the fractured end of goat femur [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 890-894.
[13]	Zhang Lei, Ma Li, Fu Shijie, Zhou Xin, Yu Lin, Guo Xiaoguang. Arthroscopic treatment of greater tuberosity avulsion fractures with anterior shoulder dislocation using the double-row suture anchor technique [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 895-900.
[14]	Zhang Jing, Wang Bin, Lü Xin. Application of anatomic intramedullary nail in tubular bone fractures of limbs: stronger holding force and anti-rotation ability [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 917-922.
[15]	Kong Lingbao, Lü Xin. Effect of implant selection and approach on support in the operation of posterolateral tibial plateau fractures [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 942-947.