| Objective:To research a treatment of old scaphoid fracture that is aproblem troubling orthopedic clinicians by assessing wrist function recoveryof the postoperative old scaphoid fracture that treated with two surgicaltreatments.Methods:From January2010to September2011,33cases of oldscaphoid fracture in our hospital were selected and randomly divided into twogroups:a experimental group with17cases and a control group with16cases.The experimental group:All patients were operated by the method ofopen reduction bone graft Kirschner wire internal fixation and styloid processof radius resection.Took a curved incision about6centimeter from the radialstyloid process to the snuffbox.Open the skin, superficial fascia layer bylayer,exposed and protected the superficial branch of radial nerve,the radialartery,the cephalic vein,the tendon of extensor pollicis longus, the tendon ofabductor pollicis longus and the tendon of extensor pollicis brevis,exposed thestyloid process of radius and the wrist articular capsule.Opened the wristarticular capsule at the radial side to expose the scaphoid fractureline,removed the styloid process of radius,and took some spongy bone as bonegraft.Removed the fibrous scar tissue that was between the fracture sites andin the medullary cavity,and removed the sclerotic bone at the fracturesites.Completely hemostatic,cleared the bone debris and blood clot in theincision and in the articular cavity.Put the spongy bone that had been takenfrom styloid process of radius into the medullary cavity and pressed thespongy bone firmly,repositioned the fracture,implanted the right amount ofspongy bone between the fracture sites and pressed firmly,maintained thefracture reduction,then,drilled crossly2or3Kirschner wires which diameterwas1.0mm from the distal pole of the scaphoid bone to the proximal pole.Made sure that the fracture was fixed firmly and that was frictionlessnessin the articular cavity by taking a motion.To ensure that the fracture reductionand internal fixation was satisfied by fluoroscopy of the wrist.Then repairedthe wrist articular capsule carefully and closed the incision.Immobilized theinjured hand at an abduction of the thumb and the wrist in neutral positionwith a plaster slab about6to12weeks postoperatively. Took an X-ray of thewrist again about6to12weeks after the operation,if there the fracture wasblurred or disappeared, trabecular bone was conjoined through the fracture andthere the bony callus was formed,then took off the plaster and removed theKirschner wires,to begin functional exercise and rehabilitationtraining.Measured the maximum angle of the wrist palmar flexion,dorsiflexion,radial deviation and ulnar deviation at the time ofpreoperative,three months postoperative and six months postoperativerespectively.The changes of the ranges of the wrist flexion-dorsiflexion andradial-ulnar deviation were analyzed statistically,that was at the time of3months after surgery and6months after surgery compared withpreoperation,then evaluated the wrist function recovery.The control group:All patients were operated by the method of openreduction and hollow screw fixation.Took a curved incision about6centimeterfrom the radial styloid process to the snuffbox.Open the skin, superficial fascialayer by layer,exposed and protected the superficial branch of radial nerve,theradial artery,the cephalic vein,the tendon of extensor pollicis longus, thetendon of abductor pollicis longus and the tendon of extensor pollicisbrevis,exposed the styloid process of radius and the wrist articularcapsule.Opened the wrist articular capsule at the radial side to expose thescaphoid fracture line.Removed the fibrous scar tissue that was between thefracture sites and in the medullary cavity,and removed the sclerotic bone atthe fracture site.Repositioned the fracture and maintained,then,drilled a guidepin from the distal pole of the scaphoid bone to the proximal pole.To makesure that the fracture reduction was satisfied and the guide pin was in themedullary cavity and crossed the fracture line trough the fluoroscopy of the wrist.Then drilled a hole along the guide pin by a hollow drill,and ensured thatit did not drill through the articular surface of the proximal pole by usingfluoroscopy.Screwed a suitable hollow screw to the scaphoid bone along theguide pin,and the tail of the screw buried under the cartilage of the scaphoid.Made sure that the fracture was fixed firmly and that was frictionlessness inthe articular cavity by taking a motion,and ensured that the fracture reductionand internal fixation was satisfied by fluoroscopy of the wrist again. Clearedthe bone debris and blood clot in the incision and articular cavity，repaired thewrist articular capsule carefully and closed the incision.Immobilized theinjured hand at an abduction of the thumb and the wrist in neutral positionwith a plaster slab about6to12weeks postoperatively. Took an X-ray of thewrist again about6to12weeks after the operation,if there the fracture wasblurred or disappeared, trabecular bone was conjoined through the fracture andthere the bony callus was formed,then took off the plaster，began to dofunctional exercises and rehabilitation training.Measured the maximum angleof the wrist palmar flexion, dorsiflexion,radial deviation and ulnar deviation atthe time of preoperative,three months postoperative and six monthspostoperative respectively.The changes of ranges of the wrist flexion-dorsiflexion and radial-ulnar deviation were analyzed statistically,that was atthe time of3months after surgery and6months after surgery compared withpreoperation,then evaluated the wrist function recovery.Results:The surgical incisions of the patients both in the control groupand in the experimental group healed very well.In the control group allpatients removed the plaster and started function training at the time ofpostoperative8±1weeks after took an X-ray of the wrist again that showedthat the fracture was blurred,trabecular bone was conjoined through thefracture,fracture healed,and internal fixation was firm.In the experimentalgroup,two cases removed the plaster and Kirschner wire and started functiontraining at the time of postoperative12weeks after took an X-ray of the wristagain that showed that the fracture was blurred,trabecular bone was conjoinedthrough the fracture and fracture healed.The other cases in the experimental group removed the plaster and Kirschner wire and started function training atthe time of postoperative8±1weeks after took an X-ray of the wrist again thatshowed that the fracture was blurred,trabecular bone was conjoined throughthe fracture and fracture healed.In the experimental group, the improved value of the wristflexion-extension ranges at the time of3month was9.18°±1.510°, theimproved value of the wrist ulnar-radial deviation ranges at the time of3month was5.29°±0.772°, the improved value of the wristflexion-extension ranges at the time of6month was18.82°±3.167°, theimproved value of the wrist ulnar-radial deviation ranges at the time of6month was11.76°±1.602°. In the control group, the improved value of thewrist flexion-extension ranges at the time of3month was12.81°±1.834°,the improved value of the wrist ulnar-radial deviation ranges at the time of3month was5.56°±1.315°, the improved value of the wristflexion-extension ranges at the time of6month was33.19°±4.102°, theimproved value of the wrist ulnar-radial deviation ranges at the time of6month was14.94°±2.351°.By contrasting the postoperative ranges of thewrist activity and the peoperative ranges of the wrist activity, the improvementin flexion-extension ranges of the wrist at the time of3month and6monthafter operation and the improvement in ulnar-radial deviation ranges of thewrist at the time of6month after operation in the control group were superiorto these in experimental group(P＜0.05),and it was not considered that theulnar-radial deviation ranges of the wrist in the control group and theulnar-radial deviation ranges of the wrist in experimental group weredifferences at the time of3month after operation(P＞0.05).Conclusions: Although the two techniques had achieved good results infracture healing,the method of open reduction and hollow screw fixation wassuperior to the method of open reduction bone graft Kirschner wire internalfixation and styloid process of radius resection in function recovery of thewrist after operation,and that was a better treatment for the old scaphoidfracture. |
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