经第四五腕掌关节钢板固定治疗钩骨体冠状面骨折  

Titanium miniplates across the fourth and fifth carpometacarpal joints for coronal fractures of the hamate

作　　者：孙丽颖[1] 杨勇[1] 李忠哲[1] 田文[1] SUN Li-ying;YANG Yong;LI Zhong-zhe;TIAN Wen(Department of Hand Surgery,Beijing Jishuitan Hospital,China,Beijing,100035)

机构地区：[1]北京积水潭医院手外科,中国100035

出　　处：《中国骨与关节杂志》2020年第11期820-826,共7页Chinese Journal of Bone and Joint

基　　金：supported by the Beijing Health system project for High-levil Technical Scholars (No 2015-3-036)

摘　　要：目的评估使用微型钛板经第四、五腕掌关节固定治疗钩骨体冠状面骨折的临床效果。方法2011年12月至2018年9月,采用微型钛板经第四、五腕掌关节固定治疗钩骨体冠状面骨折患者24例,均为男性;年龄18-51岁,平均(29.6±7.9)岁=根据Ebraheim钩骨体冠状面骨折的分型,A型3例.B型8例,C型13例均采用腕背侧入路,复位骨折与脱位后,将微型钛板经第四、五腕掌关节背侧跨关节固定钩骨体骨折与腕掌关节脱位采用臂肩手功能障碍评估表(the disabilities of the arm,shoulder and hand,DASH),疼痛视觉模拟评分(visual analogue scale,VAS)、Mayo腕关节评分、手部握力.以及环、小指总的主动活动度(total active motion,TAM)评价患者术后功能、结果24例均获得13~44个月的随访.平均(18.5±8.3)个月;钩骨骨折均完全愈合,愈合时间6~10周,平均(6.9±1.1)周”除2例外.其余22例均于术后3~6个月取出内固定物.末次随访时,DASH评分0~10.8分,平均(1.7±3.1)分;VAS评分0~3分,平均(0.5±0.9)分;Mayo腕关节评分65~100分,平均(94.2±10.0)分。手部握力患侧(42.0±4.4)kg,健侧(41.1±2.8)kg;环指与小指总的活动度患侧分别为(281±3)°和(271±6)健侧分别为(28±3)。和(272±4)°;末次随访时.活动度和握力患侧与健侧比较差异均无统计学意义:结论钩骨体冠状面骨折可采用微型钛板经腕掌关节固定。该术式固定牢固,术后骨折愈合及手部功能良好,是治疗钩骨体冠状面骨折有效的手术方法。Objective To evaluate the result of coronal fractures of the hamate with titanium miniplates across the fourth and fifth carpometacarpal joints.Methods From December 2011 to September 2018,24 patients with coronal fractures of the hamate were managed with titanium miniplates across the carpometacarpal joints.All patients were males with an average age of(29.6±7.9)years(range:18-51 years).Ebraheim's classification of hamate fractures:3 cases were of type A,8 type B,and 13 type C.All fractures were exposed using the dorsal approach.After reduction,the fractures were fixed with titanium miniplates crossing the carpometacarpal joints dorsally.The Disabilities of the Arm,Shoulder and Hand(DASH),Visual Analogue Scale(VAS),MAYO Wrist Score,grip strength,and TAM(total active motio n)of ring and little fin gers were recorded to evaluate outcomes.Results All 24 patients were followed up for 13-44 months(mean:18.5±8.3 months).Hamate fractures healed within 6-10 weeks(mean:6.9±1.1 weeks).Except two cases,all titanium miniplates and screws were removed at 3 to 6 months after surgery.Evaluation indexes at the final follow-up:DASH scores 0-10.8(mean:1.7±3.1);VAS 0-3(mean:0.5±0.9);MAYO wrist scores 65-100(mean:94.2±10.0);grip strength(42.0±4.4)kg on the injured side and(41.1±2.8)kg on the contralateral side;TAM of the ring and little fingers(281±3)°,(271±6)°on the injured side,while(283±3)°and(272±4)°on the contralateral side;No statistical differences in the grip strength and TAM between the two sides.Conclusions Coronal fractures of the hamate can be fixed with titanium miniplates crossing the carpometacarpal joints.This procedure can provide stability and allow early motion,which in turn helps maintain joint reduction and obtain good hand functions.

关 键 词：钩骨 骨折 骨折固定术 内 腕骨 

分 类 号：R683.4[医药卫生—骨科学]