中国修复重建外科杂志

中国修复重建外科杂志

维持第四、五掌骨基底间稳定性对于治疗钩骨-掌骨关节损伤的疗效分析

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目的 探讨维持第 4、5 掌骨基底间稳定性对于治疗钩骨-掌骨关节损伤的疗效。 方法 2015 年 9 月—2017 年 6 月收治 13 例闭合性钩骨-掌骨关节损伤患者,男 12 例,女 1 例;年龄 17~55 岁,平均 30.8 岁。致伤原因:拳击硬物 10 例,摔伤 3 例。单纯第 4 掌骨基底骨折 2 例,第 4 掌骨基底骨折合并掌骨间韧带断裂 1 例,第 4 掌骨基底骨折合并第 5 掌骨基底骨折 7 例,第 4 掌骨基底骨折合并第 5 掌骨基底骨折伴脱位 2 例,合并钩骨骨折的第 4、5 掌骨基底骨折 1 例。受伤至手术时间 5~11 d,平均 7.2 d。依据第 4、5 掌骨基底间稳定性改变程度进行初步分型:Ⅰ型 2 例、Ⅱ型 1 例、Ⅲ型 7 例、Ⅳ型 2 例、Ⅴ型 1 例。以复位第 4、5 掌骨基底间稳定性为原则,采取相应的手术方法内固定。 结果 术后患者切口均Ⅰ期愈合,无感染、皮肤坏死等发生。13 例患者均获随访,随访时间 6~18 个月,平均 9.4 个月。骨折均达临床愈合,愈合时间 5.5~8.0 周,平均 6.3 周。均未发生钢板断裂、骨折再脱位、骨折畸形愈合及骨不连等并发症。术后 6 个月手功能根据手外科 TAM 功能评定标准分级:优 9 例,良 3 例,可 1 例,优良率 92.3%。 结论 第 4、5 掌骨基底间稳定性对钩骨-掌骨关节损伤的分型和治疗具有重要意义。

Objective To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

关键词: 第 4、5 掌骨基底; 钩骨-掌骨关节; 分型; 跨关节内固定

Key words: The fourth and fifth metacarple base; hamate-metacarpal joint; classification; across-joint internal fixation

引用本文: 刘岸雄, 孙浩然, 姜宗圆, 欧阳阳钢, 陈琪, 谢统明, 梁海. 维持第四、五掌骨基底间稳定性对于治疗钩骨-掌骨关节损伤的疗效分析. 中国修复重建外科杂志, 2018, 32(8): 984-988. doi: 10.7507/1002-1892.201711006 复制

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