摘要
目的探讨在第4、5掌骨基底部骨折中应用跨钩骨-掌骨关节内固定技术治疗的临床效果及其疗效分析。方法2016年1月-2018年1月,共收治21例各种病因引起的第4、5掌骨基底部骨折患者,对开放性骨折予以一期清创后择期手术,闭合性骨折予以消肿处置后择期手术;所有骨折均以维持第4、5掌骨基底间稳定为前提,采用跨钩骨-掌骨关节的方法进行切开复位桥接钢板内固定。术后根据患者的疼痛视觉模拟评分(VAS评分)及中华医学会手外科学分会上肢部分功能评定标准TAM评分系统对诊疗结果进行分析评定。结果21例均获得随访,随访时间6~18个月。所有患者切口均一期愈合,未见感染、皮肤坏死等并发症发生;X线见骨折均达临床愈合,愈合时间5.2~8.4周,平均6.5周。无骨折不愈合、骨不连出现。其中2例在行内固定取出时发现钢板断裂(其取内固定时间均>4个月)。术后VAS评分平均为1.13分。手运动功能根据TAM评分系统的评定标准:优14例,良6例,可1例,差0例。结论跨关节内固定技术是治疗第4、5掌骨基底部骨折的有效方法,合理应用可以取得良好的临床疗效,值得临床推广。
Objective To investigate the clinical effect and curative analysis of the application of crossing hamate bone–metacarpal joint internal fixation technique in the treatment of the 4 th and 5 th metacarpal basal fractures.Methods From January 2016 to January 2018,a total of 21 patients with 4 th and 5 th metacarpal basal fractures caused by various causes were treated in our hospital,stage I debridement was performed for open fractures,and detumescence was performed to the closed fracture.All patients underwent elective surgery.All fractures were subjected to open reduction and bridging plate internal fixation with the method of cross hook bone and metacarpal joint on the premise of maintaining the stability between the basement of the 4 th and 5 th metacarpal.Postoperative diagnosis and treatment results were evaluated according to the visual analogue scale(VAS)of the patients and the TAM scoring system of the upper limb function assessment standard of the Chinese society of hand surgery.Results All 21 patients were followed up between 6 to 18 months.All the incisions healed in stage I,and no complications such as infection and skin necrosis were observed.All fractures observed on X-ray obtained clinical healing,and the healing time was between 5.2 to 8.4 weeks,with an average of 6.5 weeks.No fracture nonunion or bone nonunion occurred.In 2 cases,bridging plate was found broken during removal of internal fixation(>4 months).The mean VAS score was 1.13.According to the criteria of TAM scoring system,there were 14 cases of excellent,6 cases of good,1 case of fair,and 0 cases of poor.Conclusion Crossjoint internal fixation is an effective method for the treatment of the 4 th and 5 th metacarpal basal fractures.Reasonable application can obtain good clinical effect.It is worthy of clinical promotion.
作者
谢统明
孙浩然
姜宗圆
陈琪
梁海
XIE Tongming;SUN Haoran;JIANG Zongyuan(Department of the hand surgery,People's hospital of Longhua District,Shenzhen,Guangdong,518109,China)
出处
《实用手外科杂志》
2020年第3期293-296,共4页
Journal of Practical Hand Surgery
关键词
跨关节内固定
骨折
第4、5掌骨基底部
疗效
Cross-joint internal fixation
Fracture
The 4th and 5th metacarpal base
Curative effect
