闭合复位经皮克氏针横行支撑固定与切开复位微型钢板内固定治疗第5掌骨颈骨折的疗效比较  

The comparison of closed reduction combined with percutaneous Kirschner wire transverse-support fixation and open reduction microplate internal fixation in the treatment of the 5th metacarpal neck fracture

作　　者：明朝戈[1] 明立功 王自方 明立山 王新德 孟维娜 李洋洋 MING Chaoge;MING Ligong;WANG Zifang(Department of Orthopedics,Orthopedic Hospital of Hua Couty,Huaxian,Henan,456485,China)

机构地区：[1]河南省滑县骨科医院手外科,河南滑县456485 [2]滑县新区医院骨伤科,河南滑县456400

出　　处：《实用手外科杂志》2019年第4期426-429,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨闭合复位经皮克氏针横行支撑固定与切开复位微型钢板内固定治疗第5掌骨颈骨折的临床效果。方法将2012年1月-2017年2月收治的42例第5掌骨颈骨折分为两组,微创克氏针固定组22例,采用闭合复位克氏针横行支撑固定。微型钢板固定组20例,采用切开复位微型钢板内固定。比较两组的手术时间、骨愈合时间、住院时间、治疗费用、术后并发症及术后临床疗效。结果所有患者均经随访,随访时间8~54个月,平均17个月。手术时间:微创克氏针组(16.5±2.1) min,微型钢板组(45.3±7.1) min,两组比较差异有统计学意义(P<0.05)。骨愈合时间:微创克氏针组(6.5±1.1)周,微型钢板组(7.8±1.6)周,两组比较差异无统计学意义(P>0.05)。住院时间:微创克氏针组(4.5±1.2) d,微型钢板组(7.8±2.1) d,两组比较差异有统计学意义(P<0.05)。治疗费用:微创克氏针组(2 800±120)元,微型钢板组(5 400±360)元,两组比较差异有统计学意义(P<0.05)。术后并发症:微创克氏针组1例针尾处出现皮肤激惹症状,患者不适感明显,2例均有1处针孔炎性渗出,均于内固定取出后消失。微型钢板组1例于术后40 d发生内固定失效,重新更换克氏针固定后愈合,1例术后出现骨延迟愈合和功能障碍,待微型钢板取出后好转,未行特殊处理。根据术后手指关节功能TAM评分标准评定:微创克氏针组,优13例,良9例,优良率100%;微型钢板组,优7例,良9例,可4例,优良率80%。结论第5掌骨颈骨折采用闭合复位经皮克氏针横行支撑固定具有操作简便、固定可靠、经济实惠优点,易推广,是一种较理想且有效的治疗方法。Objective To discuss the clinical effect of closed reduction combined with percutaneous Kirschner wire transverse-support fixation and open reduction combined with microplate internal fixtion on the 5 th metacarpal neck fracture. Methods From January 2012 to February 2017 42 cases of the 5 th metacarpal neck fracture were divided into two groups, 22 was in Kirschner fixation group, patients were treated by closed reduction combined with K-wire fixation. 20 cases werein microplate group, the patients were treated by open reduction combined with microplate fixation. Operation time, healing time,hospital stay time, treatment cost, postoperative complication were compared. Results All patients were followed up from 8 to 54 months, with an average of 17 months. Operation time:K-wire group was(16.5±2.1)weeks, microplate group was(45.3±7.1)min, there was significant statistical difference(P<0.05).Bone healing time: K-wire group was(6.5±1.1)weeks, microplate group was(7.8 ±1.6)weeks, there was no significiant statistical difference(P >0.05). Hospital stay time: K-wire group was(4.5 ±1.2)days, microplate group was(7.8 ±2.1)weeks, there was significiant statistical difference. Postoperative complication: K-wire group: 1 case had skin irritation symptom, 2 cases had inflammation exudation, but disappeared after extraction. Microplate group: 1 case failed to fix after 40 days, but healed after changing K-wire fixation, 1 case had delayed union and dysfunction, but improved after taking out internal fixation. According to TAM scoring criteria: K-wire group: excellent in 13 cases,good in 9 cases, the excellent and good rate was 100%;microplate group: excellent in 7 cases, good in 9 cases, fair in 4 cases, the excellent and good rate was 80%. Conclusion Closed reduction combined with percutaneous K-wire transverse-support fixation to treat the 5 th meta carpal neck-fracture has the advantage of simple operation, reliable fixation, economical lost, easy popularization. It is an ideal and effective therapy.

关 键 词：第5掌骨颈骨折 微型钢板 克氏针 临床研究 

分 类 号：R687.3[医药卫生—骨科学]