顺行髓内针及微型钢板治疗移位性第5掌骨颈骨折的疗效比较  

Comparison of the antegrade intramedullary nail and mini plate for treating unstable fifth metacarpal neck fractures

作　　者：王辉[1] 郑亚东[1] 

机构地区：[1]广西壮族自治区民族医院骨科,广西南宁530001

出　　处：《实用手外科杂志》2017年第1期30-32,35,共4页Journal of Practical Hand Surgery

摘　　要：目的 比较顺行髓内钉及微型钢板治疗移位性第5掌骨颈骨折的疗效.方法 选取2013年1月-2014年12月收治30例移位性第5掌骨颈骨折病例,分为A,B两组,每组15人,A组给予微型钢板固定,B组给予顺行髓内钉固定,比较两组骨折愈合时间、术前及愈合后颈干角、术后不同时间（3,6,12个月）握力及掌指关节活动度的差异.结果 两组患者骨折愈合时间及愈合后颈干角比较差异无统计学意义（P〉0.05）,术后3个月钢板固定组握力较髓内针组高（P〈0.05）,而在6个月及12个月时两组握力比较差异无统计学意义（P〉0.05）;掌指关节活动度在3个月时两组比较差异无统计学意义（P〉0.05）,而在6个月及12个月时髓内针组高于钢板固定组（P〈0.05）.结论 切开复位掌骨微型钢板固定及闭合复位克氏针髓内固定治疗第5掌骨颈骨折均是安全有效的方法.钢板固定优势体现在早期功能锻炼,但可能需要牺牲一部分关节活动度;而克氏针髓内固定缺点在于术后石膏固定给患者生活带来不便,但后期关节的活动度能较好地保留.Objective To compare the clinical results of antegrade intramedullary nail and mini plate for treating unstable fifth metacarpal neck fractures. Methods We prospectively reviewed 30 patients with a displaced fifth metacarpal neck fracture who underwent surgery：15 with mini plates and 15 with antegrade intramedullary nails. Radiographic and clinical outcomes of both groups were compared. Objective findings of range of finger motion and grip strength were assessed at 3, 6, and 12 months postoperatively. Results There was no non-union and postoperative complications, but includ extensor tendon adhesion in one case and transient ulnar nerve lesion in one case. Radiological parameters after the fracture healing were comparable between the two groups. Postoperative 6 months and 12 months, the range of finger motion was better in patients with the intramedullary nail, and postoperative 3 months acquired grip strength in the mini plate group was superior to that in the intramedullary nail group. Conclusion The current results indicate that both procedures are highly effective in maintaining fracture restorations. Plate fixation provides earlier recovery of powerful hand function, and intramedullary nailing allows a wide range of finger motion.

关 键 词：第5掌骨颈骨折 微型铜板 克氏针 髓内固定 

分 类 号：R683.41[医药卫生—骨科学]