空心拉力螺钉治疗Bennett骨折的临床研究  

Treatment of Bennett＇s fractures with compression lag screws

作　　者：沈华[1] 沈尊理[1] 马杰[1] 顾松[1] 施剑灵 邢书亮[1] 张兆峰[1] 

机构地区：[1]上海交通大学附属第一人民医院整形外科,200080

出　　处：《中华手外科杂志》2014年第5期365-367,共3页Chinese Journal of Hand Surgery

摘　　要：目的 探讨根据骨块大小应用空心拉力螺钉治疗Bennett骨折的临床疗效.方法 2010年5月至2013年10月我科对16例Bennett骨折患者行手术治疗.术前三维CT检查,测量第一掌骨基底掌侧骨折块的大小为2.2 mm× 2.5 mm～7.5 mm× 6.7 mm,平均3.4 mm× 4.5 mm.6例骨折块纵横径≥6.0mm,骨折复位后采用克氏针固定第一、二掌骨,经桡背侧微创切口用空心拉力螺钉固定掌骨基底部及骨块.7例骨折块纵横径＜6.0 mm,3例骨块碎裂,采用空心拉力螺钉固定第一、二掌骨.术后3周拔除克氏针.复查X线片或三维CT,视骨折愈合情况去除拉力螺钉.结果 术后随访6个月至2年,去除螺钉时间为16周至8个月,平均22.6周.骨折愈合良好.对拇指运动功能、疼痛、关节面的连续性等进行疗效评价.患者运动功能优良15例,差1例;关节面连续性优13例,良2例,差1例.本组总优良率为93.8％.结论 根据骨折块大小采用空心拉力螺钉固定治疗Bennett骨折是一种简便有效的方法,创伤小,恢复快,有利于拇指早期功能锻炼,疗效满意.Objective To study the clinical results of using compression lag screws for treatment of Bennett＇s fracture.Methods From May 2010 to October 2013,sixteen patients with Bennett＇s fracture were treated with lag screws in our department.Three-dimensional CT was done and the size of fracture fragment was measured before the operation.Fracture fragments at the volar side of the first metacarpal base measured 7.5 mm× 6.7 mm to 2.2 mm × 2.5 mm.The average fragment size was 3.4 mm× 4.5 mm.There were 6 cases whose transverse dimension of fracture fragment was over 6.0 mm.A K-wire was used to stabilize the first metacarpal to the second metacarpal after fracture reduction.A compression lag screw was placed via a small dorsoradial incision to fix the fracture fragment to the metacarpal base.There were 7 cases whose transverse dimension of fracture fragment was less than 6.0 mm and 3 cases with comminuted fractures.A long compression lag screw was used to fix the first metacarpal and the second metacarpal directly through a minimal radio-dorsal incision.K-wires were removed 3 weeks postoperatively.X-ray or CT were repeated to evaluate fracture healing and determine screw removal.Results All of the 16 patients were follow-up for 6 to 24 months.The lag screws were removed between 16 weeks and 8 months,with an average of 22.6 weeks.Range of motion of the thumb,pain and congruity of the articular surface were assessed.Excellent and good functional results were achieved in 15 cases.Articular surface gap of more than 2 mm was present in 1 patient due to the comminuted fracture.The overall satisfaction rate was 93.8 %.Fractures consolidated well and no secondary displacement of the fracture occurred.Conclusion It is simple and effective to treat Bennett＇s tinctures with compression lag screw fixation based on the size of the fracture fragment.It allows early rehabilitation and leads to good functional recovery of the thumb.

关 键 词：内固定器 临床研究 BENNETT骨折 空心拉力螺钉 

分 类 号：R687.3[医药卫生—骨科学]