| Objective: It`s rarely reported that whether the radial styloid process resection+open reduction and internal fixation with bone graft is superior to simply open reduction and free bone graft+internal fixation in the treatment of old carpal scaphoid bone fracture and whether has an effect on the function of wrist joint both at home and abroad.We expect to provide some theoretical basis and help for the clinical work by this paper.Methods: There are 72 cases of patients in our hospital from2010.10 to 2016.01 conforming to the standard,and they are all diagnosed waist fracture of carpal scaphoid bone fracture.And the data of them were all analyzed retro-spectively.40 patients with experimental group(group A),32 patients with the control group(group B).Experimental group:36 male cases,4 female cases,aged from 16 to 58,on average of 27.5(20.25– 27.5).Herbert type,C type 8 cases,D1 type 12 cases,D2 type 20 cases;cause of injury,10 cases of fall,25 cases of accident,7 cases of crush injury;14 cases of left wrist,26 cases of right wrist;time from injury to see a doctor ranges from 1 to 24 months,on average of 5.5(2-11)months.Control group: 31 male cases,1 female cases,aged from 15 to 68,on average of 28.5(20–37).Herbert type,C type 2 cases,D1 type 15 cases,D2 type 15 cases;cause of injury,10 cases of fall,18 cases of accident,4cases of crush injury;11 cases of left wrist,21 cases of right wrist;time from injury to see a doctor ranges from 1 to 24 months,on average of5.5(3-11.5)months.Operation method: experimental group: the lateral and longitudinalincision of the radial styloid process,sepaate rstep by step,stretch cephalic vein and superficial branch of radial nerve to the ulnar side,incide joint capsule,expose the joint surface of radial styloid process,and fracture end of wrist scaphoid fracture,excide part of the radial styloid process to spare for bone graft(the radial styloid process for bone graft when necessary),passive wrist rotation to the radial side,ensure no extrusion from styloid process to wrist scaphoid fracture line.Shave the fibrous tissue and hardening tissue of the fracture end with curet,bone graft,compact to guarantee no separation with the fracture end.Put needle from the scaphoid nodules along the scaphoid longitudinal axis,ensure fluoroscopy location is good.Put Herbert screw into the hole after drilling and reaming,fix with pressure,suture the wounds layer by layer and dress them by bandage.Control group: apply the same way of incision and fixation without radial styloid process resection.Bone graft choice(less need of bone mass,apply part of the distal radius cancellous bone to bone graft,take iliac bone when needing structural bone block).Postoperative situation:the wrist motion and grip strength and subjective feelings of pain of patients in two groups were collected five months after fracture healing to be compared with the contralateral.The Mayo is used to wrist score.The measurement data was shown with median(inter-quartitle range),the enumeration data was shown with percentage.T test was used for comparison between groups;P < 0.05 was statistically significant.Results:1 General ConditionsExperimental follow-up ranges from 12 to 48 months,on average of40 months,the control follow-up ranges from 13 to 48 months,on average of 42 months.There are no screw out fracture,internal fixation failure and other complications during the follow-up period.Two groups of patients share statistical significance(P > 0.05 in gender,age,injury toclinical time statistical analysis).2 Radiographic EvaluationAll patients got osseous healing.Healing time of experimental group varied from 3 to 12 months,on average of 4(3-5)months,that of control group varied from 3.5-7 months,on average of 4(3.125-5)months,the comparison of two groups share no statistical significance(P>0.05).Comparing the preoperative and postoperative PACS image of patients of experimental group,the angle of radial styloid process section varied from32.1 ° to 60.1 °,the removal of the articular surface accounted for7.15%-11.90% of distal radius articular surface.3 Functional Recovery of Wrist JointThe contralateral wrist joint mobility of experimental group is between 50%-100%,on average of 88%(80%-90%);Grip strength of contralateral wrist joint is between 50%-100%,on average of100%(80%-100%).The contralateral wrist joint mobility of control group is between 35%-100%,on average of 75%(56%-85%);Grip strength is between 40%-100%,on average of 75%(60%-85%).There is statistical significance(P < 0.05)by analyzing the wrist activity percentage and grip strength percentage of two groups of patients statistically.4 The Postoperative Pain15 cases of experimental group felt pain in different degree,10 cases of mild pain,5 cases of occasional pain.The rate of pain accounts for37.5%.22 cases of control group felt pain in different degree,16 cases of moderate pain,2 cases of occasional pain.The rate of pain accounts for68.8%.The comparison of two groups share statistically significance(P<0.05).5 The Mayo score13 cases of experimental group range in first-class,16 in favorable-class,11 in passable-class.The rate of ex-cellent accounts for72.50%.2 cases of control group range in first-class,7 in favorable-class,9in passable-class.The rate of excellent accounts for 28.10%.Thecomparison of two groups share statistically significance(P<0.05).Conclusion:1 The radial styloid process resection+open reduction and internal fixation with bone graft is superior to simply open reduction and free bone graft+internal fixation in the treatment of old carpal scaphoid bone fracture and performs outstanding in functional recovery of wrist joint and the postoperative pain and so on.2 The radial styloid process resection+open reduction and internal fixation with bone graft has fewer complications in in the treatment of old carpal scaphoid bone fracture and is worth prmoting. |
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