双钢板固定治疗第一掌骨基底部粉碎性骨折  

Double locking mini-plates for fixation of comminuted fracture of the first metacarpal base

作　　者：郭玉冬[1] 钱方媛[1] 王善正[1] 俞佳斌 马良彧 贾军 王宸[1] Guo Yudong, Qian Fangyuan, Wang Shanzheng, Yu Jiabin, Ma Liangyu, Jia Jun, Wang Chen(Department of Orthopaedic Trauma, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, Chin)

机构地区：[1]东南大学附属中大医院创伤骨科,南京210009

出　　处：《中华创伤骨科杂志》2018年第3期254-257,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81572188）

摘　　要：目的探讨双钢板固定治疗第1掌骨基底部粉碎性骨折的临床疗效。方法回顾性分析2013年1月至2016年1月期间收治的24例第1掌骨基底部粉碎性骨折患者资料。男17例，女7例；年龄为27～65岁，平均33．5岁；骨折根据Green分型：Ⅰ型（Bennett骨折）6例，Ⅱ型（Rolando骨折）13例，Ⅲ型（关节外骨折）5例，均为闭合性损伤。受伤至手术时间平均为2．3d（8h至7d）。采用背侧纵形切口，复位骨折后予2枚微型锁定钢板从背侧及桡侧固定骨折。术后随访观察患者的骨折愈合时间、疼痛情况及手指关节功能等。术后12个月采用视觉模拟评分评定患者疼痛情况，末次随访时采用手指关节总活动度评分标准评定患指功能。结果24例患者术后获8～28个月（平均18个月）随访。本组患者的骨折愈合时间为9，12周（平均10．5周）。术后12个月疼痛VAS评分为0～3分，平均1．5分。末次随访时按照手指关节总活动度评分标准评定患指功能：优20例，良4例，优良率为100％。2例患者主诉手指活动过多后出现酸痛。随访期间无一例患者发生皮肤感染、裂开、第l腕掌关节脱位、钢板断裂、移位、皮瓣坏死及软组织激惹等并发症，患者骨折愈合后外观未见明显成角及旋转畸形。结论双钢板内固定可有效治疗第1掌骨基底部粉碎性骨折，可提供双平面可靠固定，有利于术后患者早期进行手指关节功能锻炼，避免关节僵硬，是一种比较可行的内固定方式。Objective To investigate the clinical efficacy of double locking mini-plates for fixation of the comminuted fracture of the first metacarpal base. Methods Twenty-four patients with the comminuted fracture of the first metacarpal base were treated by double locking mini-plates in our hospital from January 2013 to January 2016. They were 17 males and 7 females, from 27 to 65 years of age （average, 33.5 years）. By the Green classification, 6 cases were type Ⅰ, 13 cases type Ⅱ and 5 cases type Ⅲ. All the fractures were closed. The average time from injury to surgery was 2.3 days （from 8 hours to 7 days） . After open reduction via the palmar-radial incision, the fracture was fixated with 2 mini-plates, one locking T-plate on the radial side and one straight locking plate on the dorsal side. Fracture healing time, pain and finger function were followed up postoperatively. Visual analogue scale （VAS） was used to evaluate the pain at 12 months and scoring for digital total range of motion to assess the function of the affected finger at the final follow-up. Results The 24 patients obtained follow-up for 8 to 28 months （average, 18 months） . All the Fractures healed after 9 to 12 weeks （average, 10.5 weeks）. The VAS scores at 12 months ranged from 0 to 3 （average, 1.5）. The function of the affected finger at the final follow-up was excellent in 20 cases and good in 4, giving an excellent to good rate of 100%. Two patients complained of pain after frequent motion of the finger. No complications like skin problems, dislocation of the first metacarpal base, implant failure, necrosis or irritation of the soft tissue were observed during follow-up. No angulation or rotational deformity occurred after fracture union. Conclusion Fixation with double locking mini-plates can effectively treat comminuted fractures of the first metacarpal base, because it can provide rigid stabilization which promotes early functional exercise of the finger, and prevents joint stiffness as well.

关 键 词：掌骨 骨折 骨折固定术 内 骨板 

分 类 号：R687.3[医药卫生—骨科学]