| 记忆合金Ⅰ型钉脚固定器联合克氏针治疗经舟骨月骨周围背侧脱位的临床疗效研究 |
| A study on the clinical efficacy of type I memory alloy nail-foot fixator combined with Kirschner wire for dorsal dislocation around the lunate in trans-scaphoid perilunate dorsal dissociation |
| 投稿时间：2024-09-03 |
| DOI：10.3969/j.issn.1672-5972.2025.06.005 |
| 中文关键词: 腕关节 经舟骨月骨周围背侧脱位 记忆合金I型钉脚固定器 |
| 英文关键词:Wrist Trans-scaphoid perilunate dorsal dislocation Type I memory alloy nail-foot fixator |
| 基金项目:国家重点研发计划（2022YFC2405704）；云南省创伤骨科临床医学中心（第二周期）；云南省骨科与运动康复临床医学研究中心（二期） |
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| 中文摘要: |
| 目的 探讨记忆合金Ⅰ型钉脚固定器（memory alloy nail-foot fixator, MANFF）联合克氏针在治疗经舟骨月骨周围背侧脱位时未行月三角韧带修复的患者的临床效果，报告至少随访1年以上的疗效。方法 回顾性分析中国人民解放军联勤保障部队第九二〇医院2017年1月至2020年12月采用手术治疗的未行月三角韧带修复的经舟骨月骨周围背侧脱位患者60例。根据手术方法分为应用记忆合金Ⅰ型钉脚固定器联合克氏针治疗患者30例（联合固定组）和应用克氏针治疗患者30例（克氏针组）。记录两组的手术时间、愈合时间，握力、疼痛视觉模拟评分量表（VAS），观察舟骨骨折愈合率；根据Krimmer评分表进行腕关节功能评价临床疗效。结果 所有患者随访12～37个月，平均（18.70±6.25）个月。①手术时间与愈合时间：两组的手术时间比较，差异无统计学意义（P＞0.05），但联合固定组的骨折愈合时间显著短于克氏针组（P＜0.05）。②握力恢复：两组患者的握力在术后6个月均较术前显著提高（P＜0.05）。组间比较显示，联合固定组术后6个月握力显著高于克氏针组（P＜0.05）。③疼痛缓解：两组患者的VAS评分在术后6个月均较术前显著降低（P＜0.05）。组间比较显示，联合固定组术后6个月VAS评分显著低于克氏针组（P＜0.05）。④腕关节功能恢复：根据Krimmer评分，两组患者的评分在术后3、6个月及末次随访时均较术前显著提高（P＜0.05），且联合固定组在术后6个月及末次随访时的评分仍有显著提升（P＜0.05），而克氏针组未见明显变化。末次随访时，联合固定组评分显著高于克氏针组（P＜0.05）。⑤骨折愈合率：联合固定组骨折愈合率为93.33%，显著高于克氏针组的86.67%（P＜0.05）。⑥两组患者术后切口均Ⅰ期愈合，无感染、内固定物松动及断裂等并发症发生。结论 记忆合金Ⅰ型钉脚固定器联合克氏针在治疗经舟骨月骨周围背侧脱位（未修复月三角韧带）时能够有效缩短骨折愈合时间，促进握力恢复、改善腕关节功能、缓解疼痛，并且具有较高的骨折愈合率和较低的并发症发生率。因此，该方法是一种安全有效的治疗选择，尤其适用于复杂病例或需要长期稳定固定的患者。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of type Ⅰ memory alloy nail-foot fixator (MANFF) combined with Kirschner wire in the treatment of trans-scaphoid perilunate dorsal dislocation without lunotriquetral interosseous ligament repair, and a follow-up period of at least 1 year was reported.Methods A retrospective analysis was conducted on 30 patients with trans-scaphoid perilunate dorsal dislocation who did not undergo lunotriquetral interosseous ligament repair and who were treated with a type I MANFF combined with Kirschner wire at the 920th Hospital of the Joint Logistic Support Force of People's Liberation Army of China between January 2017 and December 2020. Additionally, 30 cases of dorsal dislocation of the transscapholunate ligament without lunate ligament repair were treated with Kirschner needles. Operation time, healing time, grip strength, and visual analogue scale (VAS) scores were recorded. Evaluation of scaphoid fracture healing progression was based on anteroposterior and lateral wrist radiographs. The clinical efficacy of wrist function was evaluated according to the Krimmer score.Results All patients were followed up for 12 to 37 months, with a mean follow-up period of (18.70±6.25) months. The postoperative follow-up results showed that: ① Operation time and healing time: There was no significant difference in operation time between the two groups (P>0.05), but fracture healing time was significantly shorter in the combined fixation group than that in the Kirschner wire group (P<0.05). ② Grip strength recovery: Grip strength in both groups improved significantly 6 months after surgery compared to pre-surgery levels (P<0.05). Inter-group comparison showed that the grip strength of the combined fixation group was significantly higher than that of the Kirschner wire group 6 months after surgery (P<0.05). ③ Pain relief: The VAS scores of both groups were significantly lower than those before surgery at 6 months after surgery (P<0.05). Intergroup comparison showed that the VAS score of the combined fixation group was significantly lower than that of the Kirschner wire group at 6 months after surgery (P<0.05). ④ Recovery of wrist joint function: According to the Krimmer score, the scores of both groups were significantly improved at 3 months, 6 months and the last follow-up after surgery compared with those before surgery (P<0.05), and the scores of the combined fixation group were still significantly improved at 6 months and the last follow-up after surgery (P<0.05), while no significant changes were found in the Kirschner wire group. At the last follow-up, the score in the combined fixation group was significantly higher than that in the Kirschner wire group (P<0.05). ⑤ Fracture healing rate: The fracture healing rate in the combined fixation group was 93.33%, which was significantly higher than that in the Kirschner wire group (86.67%) (P<0.05). ⑥ The incisions of both groups healed within the first stage after surgery and there were no complications such as infection, loosening or fracture of the internal fixation.Conclusion The type Ⅰ memory alloy nail-foot fixator combined with Kirschner wire has significant advantages in the treatment of dorsal dislocation of the scaphoid and lunate (without repair of the lunotriquetral ligament). It effectively shortens fracture healing time, promotes grip strength recovery, improves wrist function and relieves pain. It also has a high fracture healing rate and a low complication rate. Therefore, this method is a safe and effective treatment option, especially for complex cases or patients who require long-term stable fixation. |
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