Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Yujian ¹ ,  XU Yongqing ² , HE Xiaoqing ² , LI Chuan ² , YANG Xi ² , ZHANG Xulin ² , ZHAO Wanqiu ²

1. The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China;
2. Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China;

Corresponding?author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Trans-scaphoid perilunate dislocation; nitinol memory alloy two foot fixator; open reduction; internal fixation

DOI：

10.7507/1002-1892.201911013

Video：

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Objective To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.Methods Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert’s classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score.Results All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation (P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation (P<0.05). There was no significant difference between at 6 months and last follow-up (P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%.Conclusion Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.

Citation： XU Yujian, XU Yongqing, HE Xiaoqing, LI Chuan, YANG Xi, ZHANG Xulin, ZHAO Wanqiu. Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 671-675. doi: 10.7507/1002-1892.201911013 Copy

1.	Drac P, Cizmar I, Manak P, et al. Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2014, 158(2): 277-281.
2.	Kim JP, Lee JS, Park MJ. Arthroscopic reduction and percutaneous fixation of perilunate dislocations and fracture-dislocations. Arthroscopy, 2012, 28(2): 196-203.
3.	王孝輝, 王慶豐, 張彩麗. 超聲引導下經皮 Herbert 螺釘治療新鮮無移位腕舟骨骨折. 中國修復重建外科雜志, 2018, 32(8): 989-992.
4.	楊晨光, 陳亮, 胡韶楠. 急性腕舟骨骨折的診斷治療研究進展. 中國修復重建外科雜志, 2019, 33(4): 507-510.
5.	Kremer T, Wendt M, Riedel K, et al. Open reduction for perilunate injuries—clinical outcome and patient satisfaction. J Hand Surg (Am), 2010, 35(10): 1599-1606.
6.	Varga P, Zysset PK, Schefzig P, et al. A finite element analysis of two novel screw designs for scaphoid waist fractures. Med Eng Phys, 2016, 38(2): 131-139.
7.	牛升波, 曹學成. 切開復位內固定治療急性經舟骨月骨周圍脫位. 中醫正骨, 2015, 27(4): 59-61.
8.	?olak I, Bekler HI, Bulut G, et al. Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation. Acta Orthop Traumatol Turc, 2018, 52(1): 32-36.
9.	周炎, 劉世清, 余鈴, 等. 經三關節克氏針固定結合骨錨修復治療急性期月骨周圍損傷. 中國修復重建外科雜志, 2014, 28(9): 1086-1090.
10.	賈晶, 趙玲瓏, 石宇. 切開復位無頭空心加壓螺釘固定結合腕骨間韌帶修復治療新鮮經舟骨月骨周圍脫位. 中國骨與關節損傷雜志, 2015, 30(7): 772-773.
11.	Apergis E. Acute perilunate dislocations and fracture dislocations//Apergis E, ed. Fracture Dislocations of the Wrist. Italia: Springer-Verlag, 2013: 61-137.
12.	徐輝豪, 黃俊伍. Herbert 螺釘內固定和石膏外固定治療腕舟骨穩定型骨折的比較研究. 中華手外科雜志, 2016, 32(2): 85-86.
13.	徐達傳, 黃美賢. 手舟骨的形態血供特點及其臨床意義. 中華關節外科雜志 (電子版), 2010, 4(2): 251-255.
14.	孔維云, 徐永清, 王宇飛, 等. 鎳鈦記憶合金腕舟骨內固定器的研制及生物力學測試. 中國修復重建外科雜志, 2008, 22(1): 48-52.
15.	張旭林, 徐永清, 何曉清. 手舟骨腰部骨折 3 種內固定方式的有限元分析. 中國臨床解剖學雜志, 2019, 37(5): 553-558.
16.	曾俊, 林旭, 鐘澤蒞, 等. 個體化經皮空心螺釘內固定治療 Herbert Ⅰb 型腕舟骨骨折臨床研究. 中國修復重建外科雜志, 2016, 30(10): 1189-1194.
17.	董豐樂, 馮衛華. 外固定支架聯合空心螺釘克氏針內固定治療經舟骨月骨周圍脫位的效果. 社區醫學雜志, 2018, 16(2): 31-32.
18.	張立國. 經舟骨月骨周圍脫位治療 11 例臨床分析. 世界最新醫學信息文摘, 2019, 19(44): 103-105.

1. Drac P, Cizmar I, Manak P, et al. Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2014, 158(2): 277-281.
2. Kim JP, Lee JS, Park MJ. Arthroscopic reduction and percutaneous fixation of perilunate dislocations and fracture-dislocations. Arthroscopy, 2012, 28(2): 196-203.
3. 王孝輝, 王慶豐, 張彩麗. 超聲引導下經皮 Herbert 螺釘治療新鮮無移位腕舟骨骨折. 中國修復重建外科雜志, 2018, 32(8): 989-992.
4. 楊晨光, 陳亮, 胡韶楠. 急性腕舟骨骨折的診斷治療研究進展. 中國修復重建外科雜志, 2019, 33(4): 507-510.
5. Kremer T, Wendt M, Riedel K, et al. Open reduction for perilunate injuries—clinical outcome and patient satisfaction. J Hand Surg (Am), 2010, 35(10): 1599-1606.
6. Varga P, Zysset PK, Schefzig P, et al. A finite element analysis of two novel screw designs for scaphoid waist fractures. Med Eng Phys, 2016, 38(2): 131-139.
7. 牛升波, 曹學成. 切開復位內固定治療急性經舟骨月骨周圍脫位. 中醫正骨, 2015, 27(4): 59-61.
8. ?olak I, Bekler HI, Bulut G, et al. Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation. Acta Orthop Traumatol Turc, 2018, 52(1): 32-36.
9. 周炎, 劉世清, 余鈴, 等. 經三關節克氏針固定結合骨錨修復治療急性期月骨周圍損傷. 中國修復重建外科雜志, 2014, 28(9): 1086-1090.
10. 賈晶, 趙玲瓏, 石宇. 切開復位無頭空心加壓螺釘固定結合腕骨間韌帶修復治療新鮮經舟骨月骨周圍脫位. 中國骨與關節損傷雜志, 2015, 30(7): 772-773.
11. Apergis E. Acute perilunate dislocations and fracture dislocations//Apergis E, ed. Fracture Dislocations of the Wrist. Italia: Springer-Verlag, 2013: 61-137.
12. 徐輝豪, 黃俊伍. Herbert 螺釘內固定和石膏外固定治療腕舟骨穩定型骨折的比較研究. 中華手外科雜志, 2016, 32(2): 85-86.
13. 徐達傳, 黃美賢. 手舟骨的形態血供特點及其臨床意義. 中華關節外科雜志 (電子版), 2010, 4(2): 251-255.
14. 孔維云, 徐永清, 王宇飛, 等. 鎳鈦記憶合金腕舟骨內固定器的研制及生物力學測試. 中國修復重建外科雜志, 2008, 22(1): 48-52.
15. 張旭林, 徐永清, 何曉清. 手舟骨腰部骨折 3 種內固定方式的有限元分析. 中國臨床解剖學雜志, 2019, 37(5): 553-558.
16. 曾俊, 林旭, 鐘澤蒞, 等. 個體化經皮空心螺釘內固定治療 Herbert Ⅰb 型腕舟骨骨折臨床研究. 中國修復重建外科雜志, 2016, 30(10): 1189-1194.
17. 董豐樂, 馮衛華. 外固定支架聯合空心螺釘克氏針內固定治療經舟骨月骨周圍脫位的效果. 社區醫學雜志, 2018, 16(2): 31-32.
18. 張立國. 經舟骨月骨周圍脫位治療 11 例臨床分析. 世界最新醫學信息文摘, 2019, 19(44): 103-105.

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Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation

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