中国修复重建外科杂志

中国修复重建外科杂志

微型锁定钢板跨腕掌关节内固定治疗第五掌骨基底部粉碎性骨折

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目的 探讨微型锁定钢板跨腕掌关节内固定治疗第 5 掌骨基底部粉碎性骨折的临床疗效。 方法 2015 年 7 月—2017 年 12 月,共收治第 5 掌骨基底部粉碎性骨折患者 8 例,其中男 7 例,女 1 例;年龄 19~45 岁,平均 32.5 岁。致伤原因:握拳时击打坚硬物体致伤 2 例,摔伤 6 例。合并第 5 腕掌关节半脱位 2 例,脱位 1 例。受伤至手术时间 1~5 d,平均 3.5 d。经术前评估不超关节固定或短时间超关节固定不能维持骨折端稳定性,故均采用切开复位微型锁定钢板跨腕掌关节内固定。术后观察并发症发生情况及骨折愈合情况;末次随访时按照中华医学会手外科学分会推荐的小指总主动活动度(total active motion,TAM)评价方法评价手部功能。 结果 术后患者切口均Ⅰ期愈合,均未发生切口感染、皮缘坏死、肌腱或神经损伤等并发症。8 例患者均获随访,随访时间 6~18 个月,平均 12 个月。骨折均愈合,愈合时间 12~16 周,平均 13 周。术后 4 个月内患者均能返回受伤前工作岗位。末次随访时按照中华医学会手外科学分会推荐的小指 TAM 评价方法评价手部功能,获优 7 例、良 1 例,优良率 100%。 结论 采用微型锁定钢板跨腕掌关节内固定治疗不超关节固定或短时间超关节固定不能维持骨折端稳定性的第 5 掌骨基底部粉碎性骨折疗效满意,可作为一种备选手术治疗方案。

Objective To evaluate the effectiveness of open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate for treatment of comminuted fracture of base of the fifth metacarpal. Methods Between July 2015 and December 2017, 8 cases of comminuted fractures of base of the fifth metacarpals were treated with open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate. There were 7 males and 1 female with an age of 19-45 years (mean, 32.5 years). The causes of injury included 2 cases of hitting hard objects while clenching fist, 6 cases of falling injuries. There were 2 cases of subluxation of fifth carpal joints and 1 case of dislocation. The time from injury to operation was 1-5 days (mean, 3.5 days). The stability of fracture ends could not be maintained by preoperative evaluation without over articular fixation or short time over articular fixation. Postoperative complications and fracture healing were observed, and hand function was evaluated at last follow-up according to the total active motion (TAM) recommended by the Chinese Medical Association Hand Surgical Science Branch. Results All the incisions healed in the first stage without complications such as wound infection, cutaneous necrosis, tendon, or nerve injury. All the patients were followed up 6-18 months (mean, 12 months). All fractures healed with the healing time of 12-16 weeks (mean, 13 weeks). Within 4 months after operation, all patients were able to return to work before injury. At last follow-up, according to the TAM evaluation method recommended by the Chinese Medical Association Hand Surgical Science Branch, the results were excellent in 7 cases, good in 1 case, with the excellent and good rate of 100%. Conclusion Applying of mini locked-plate for treatment of comminuted fractures of base of the fifth metacarpals, of which cannot obtain stable fixation through non-transarticular or short-time transarticular fixation, can achieve satisfactory functional results with very few complications through trans-carpometacarpal joint approach, thus the procedure can be selected as an operation scheme.

关键词: 微型锁定钢板; 粉碎性骨折; 第 5 掌骨基底部; 跨腕掌关节; 内固定

Key words: Mini locked-plate; comminuted fracture; base of the fifth metacarpal; trans-carpometacarpal joint approach; internal fixation

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