钉脚固定器在治疗舟骨、大小多角骨陈旧性脱位中的应用

作者	单位	邮编
王腾^*	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
蔡兴博	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
李朝波	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
吕黎明	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
陈雪	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
范新宇	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
王波	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032
徐永清^*	中国人民解放军联勤保障部队第九二〇医院骨科,云南昆明,650032	650032

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中文摘要:

目的探讨应用镍钛记忆合金三角钉脚固定器行舟骨、大小多角骨（scapho-trapezio-trapezoid, STT）局限性腕骨融合术在治疗舟骨、大小多角骨陈旧性脱位中的临床疗效。方法回顾性分析2015年1月至2023年1月中国人民解放军联勤保障部队第九二〇医院骨科收治的6例舟骨、大小多角骨陈旧性脱位并应用镍钛记忆合金三角钉脚固定器行STT融合术的患者资料，运用视觉模拟评分法（VAS评分）以及Cooney腕关节评分（改良Green和O′Brien腕关节评分或Mayo腕关节评分）和患者腕关节评分表（PRWE）两种腕关节功能评定方法对术前及末次随访时进行评分，评估该治疗方法的临床疗效。结果所有患者均得到有效的随访，随访时间14 ～ 60个月，平均（27.83±17.62）个月。患者均未出现感染、内固定失效、STT再次脱位等并发症，术后STT骨性融合率100%。末次随访时，VAS评分［（2.67±0.82）分］较术前［（5.33±1.03）分］显著降低（P＜0.05），Cooney腕关节评分［（83.33±4.68）分］较术前［（48.00±13.08）分］显著升高（P＜0.05），PRWE评分［（39.67±10.25）分］较术前［（77.17±5.53）分］显著降低，差异均有统计学意义（P＜0.05）。结论应用镍钛记忆合金三角钉脚固定器行STT融合术在治疗舟骨、大小多角骨陈旧性脱位中疗效确切，手术操作简单，创伤小、无明显并发症，值得临床推广应用。

英文摘要:

Objective To investigate the clinical efficacy of using nickel-titanium memory alloy three corner nail-foot fixators for scapho-trapezio-trapezoid (STT) arthrodesis in the treatment of chronic scapho-trapezio-trapezoid dislocation.Methods The retrospective study analyzed data of six patients diagnosed as chronic scapho-trapezio-trapezoid dislocation and treated at the 920th Hospital of the Joint Logistics Support Force of People's Liberation Army of China from January 2015 to January 2023. All six patients accepted STT arthrodesis with triangular nail-foot fixators made of nickel-titanium memory alloy. Clinical efficacy was assessed by the visual analogue scale (VAS), Cooney wrist scores (modified Green and O'Brien wrist scores or Mayo wrist scores), and the Patient-Rated Wrist Evaluation (PRWE) at pre-operative and the final follow-up.Results All patients accepted an effective follow-up of 14 to 60 months, with a mean follow-up of (27.83±17.62) months. No complications such as infection, failure of internal fixation and STT re-dislocation occurred in any of the patients, and the postoperative STT bone fusion rate was 100%. The results showed that the VAS scores (2.67±0.82) declined significantly at the final follow-up compared the preoperative value (5.33±1.03) (P<0.05). The average Cooney wrist score at the final follow-up was (83.33±4.68), which was significantly higher than that at pre-operation [(48.00±13.08)] (P<0.05). The average PRWE score significantly dropped from (77.17±5.53) at pre-operation to (39.67±10.25) at the final follow-up (P<0.05).Conclusion The use of nickel-titanium memory alloy three corner nail-foot fixators for STT arthrodesis is effective in treating chronic scapho-trapezio-trapezoid dislocation. The procedure is simple, minimally invasive, and without significant complications, making it worthy of clinical application.

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