摘要
目的探讨微型钛板经腕掌关节固定治疗钩骨体冠状面骨折的临床疗效。方法收集2011年12月至2015年6月采用微型钛板经腕掌关节固定治疗钩骨体冠状面骨折的患者17例，均为男性；年龄18～43岁，平均（28．9±7．0）岁；受伤至手术时间为3-30d，平均（10．6±7．4）d。根据Ebraheim钩骨体冠状面骨折分型，A型2例，B型5例，C型10例。术中均采用腕掌关节背侧入路显露，骨折与脱位复位后，微型钛板经腕掌关节放置于掌骨干和钩骨体的背侧以固定钩骨体骨折与腕掌关节脱位。采用臂肩手功能障碍评估表（the disabilities of the arm，shoulder and hand，DASH）、疼痛视觉模拟评分（visual analogue scale，VAS）、Mayo腕关节评分、患侧和健侧手部握力，以及环、小指总的主动活动度（total active motion，TAM）评价患者术后功能，同时随访摄腕关节X线片。结果17例均获得随访，随访时间13-42个月，平均（18．1±7．2）个月；钩骨骨折均完全愈合，愈合时间6-10周，平均（7．1±1．1）周。除2例超过6个月外，所有患者均于术后3。4个月取出内固定物。末次随访时，DASH评分0-10．8分，平均（1．9±3．5）分；VAS评分0-3分，平均（0．5±0．9）分；Mayo腕关节评分65-100分，平均（93．8±10．7）分。末次随访时，手部握力患侧（42．4±4．8）kg，健侧（41．6±2．9）kg；环指与小指总的活动度患侧分别为280°±5°和271°±6°，健侧分别为281°±3°和272°±4°，握力和活动度患侧与健侧比较均无统计学差异。结论钩骨体冠状面骨折可采用微型钛板经腕掌关节固定，该术式固定牢靠，有助于维持关节复位，术后骨折愈合及手部功能良好，是治疗钩骨体冠状面骨折有效的手术方法。
Objective To evaluate the treatment effects of coronal fracture of the hamate with fixation of titanium mini- plate crossing carpometacarpal joint. Methods From December 2011 to June 2015, 17 patients suffered from coronal fracture of the hamate were treated with fixation of titanium miniplate crossing carpometacarpal joint. The patients were all males, aged from 18 to 43 years, average （28.9±7.0） years. According to the classification of Ebraheim＇ s hamate body fracture, 2 cases were type A, 5 cases were type B, 10 cases were type C. All the hamate fractures were exposed by dorsal approach. After the reduction, the frac- tures were fixed with titanium miniplate crossing carpometaearpal joint dorsally. The disabilities of the ann, shoulder and hand （DASH）, visual analogue scale （VAS）, MAYO Wrist Score, grip strength and ring and small fingers total active motion （TAM） were employed to evaluate the functions. All patients took X rays during follow-up. Results All patients were followed up 13-42 months, average （18±7） months. Hamate fractures were healed 6-10 weeks, average （7.1±1.1） weeks. Except 2 cases, all titanium miniplates and screws were removed at 3-4 months post-operatively. At final follow-up, DASH scores were from 0-10.8, with an average 1.9±3.5. MAYO Wrist Scores were from 65-100, with an average 93.8±10.7. Grip strength averaged （42.4 ± 4.8） kg on the injured side and averaged （41.6±2.9） kg on the contralateral side. TAM of the ring and small fingers were 280°±5° and 271°±6° on the injured side, meanwhile 281°±3° and 272°±4° on the contralateral side. Grip strength and TAM of both sides showed no statis- tical significance. Conclusion Coronal fracture of hamate could be fixed with titanium miniplate crossing carpometacarpal joint. The procedure could provide stability and allow early motion, which could help maintain joint reduction and obtain reliable frac- ture healing and good hand function. This technique may be an optional choice in clinical pr
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第2期105-112,共8页
Chinese Journal of Orthopaedics
基金
北京市卫生系统高层次卫生技术人才培养计划（2015-3-036）
人力资源和社会保障部留学人员科技活动项目择优资助
关键词
钩骨
骨折
骨折固定术
内
临床方案
Hamate bone
Fractures
Fracture fixation, internal
Clinical protocols
