掌侧经皮Herbert螺钉内固定并注入aFGF治疗26例不稳定型腕舟骨骨折

目的：评价掌侧经皮Herbert螺钉内固定治疗不稳定型腕舟骨骨折的I临床价值及酸性成纤维细胞生长因子(aFGF)对腕舟骨骨折愈合的作用。方法：26例不稳定型腕舟骨骨折患，采用掌侧经皮Herbert螺钉内固定治疗，术中骨折处注入aFGF透明质酸凝胶。结果：26例中25例获随访，随访时间平均11．4个月。25例骨折全部愈合，愈合时间平均为术后3．6个月。25例伤腕没有疼痛，握力良好。2例腕关节活动轻度受限，另23例患侧腕关节桡偏、尺偏、背伸、掌屈活动与健侧相比无明显差别。结论：掌侧经皮Herbert螺钉内固定治疗不稳定型腕舟骨骨折具有创伤小、骨折固定牢靠、术后可早期功能锻炼、手腕功能恢复好、内固定无需取出等优点。术中加用aFGF’透明质酸凝胶对骨折愈合可能有促进作用。

Treatment of instable scaphoid fracture with herbert screw through percutaneous palmar approach and instilled with aFGF

Aim: To evaluate clinical value of treatment of instable scaphoid fracture with Herbert screw through percutaneus palmar approach and the effect of hyaluronic acid gel (HAG) combined with acid fibroblast growth factor (aFGF) on promoting the healing of scaphoid fracture. Methods: Twenty-six cases with of instable scaphoid fracture were treated with Herbert screw through percutaneous palmar approach, combined with using HAG and aFGF instilled into the place of fracture at operation. Results: Twenty-five patients of 26 were followed up for an average 11.4 months. The average healing period of 25 cases was 3.6 months. No case had wrist pain. All cases had good grip strength. There were 23 cases with normal wrist motion in flexion and extension, radial deviation and ulnar deviation, only 2 cases with light limited wrist motion. Conclusion: Inner fixation with Herbert screw through percutaneous palmar approach is a preferable method for instable scaphoid fracture, with less trauma, rigider fixation, earlier rehabilitation, better function in wrist motion and not necessary to removal the implant. HAG combining with aFGF instilled into the place of fracture at operation might promote fracture healing.