克氏针与钢板治疗第一掌骨基底部关节外骨折的疗效及其对机体应激水平的对比研究  

Effect of Kirschner wire and plate in the treatment of extrararticular fracture of the base of the first metacarpal bone and its comparative study on stress level of the body

作　　者：袁涛 马雪峰 郭刚 张青春 王立新[2] YUAN Tao;MA Xue-feng;GUO Gang(Department of Orthopedics,Bozhou Hospital of Traditional Chinese Medicine,Bozhou Anhui 236800,China)

机构地区：[1]亳州市中医院骨科,安徽亳州236800 [2]上海交通大学医学院附属新华医院崇明分院骨科,上海202150

出　　处：《临床和实验医学杂志》2021年第8期859-862,共4页Journal of Clinical and Experimental Medicine

基　　金：2018年安徽省医学会临床研究项目(编号:201827)。

摘　　要：目的比较克氏针与钢板治疗第一掌骨基底部关节外骨折的疗效及机体应激水平。方法回顾性研究2017年6月至2019年6月于亳州市中医院骨科治疗的56例第一掌骨基底部关节外骨折患者的临床资料,根据手术方法不同将其分为克氏针组(n=28)和钢板组(n=28),克氏针组患者行克氏针内固定治疗,钢板组患者行钢板固定治疗。观察2组患者手术时间、术中出血量、切口长度及骨折愈合时间。观察术前、术后7 d血清超氧化物歧化酶(SOD)、皮质醇(Cor)、血管紧张素-2(Ang-Ⅱ)及去甲肾上腺素(NE)等应激因子水平,术后并发症及拇指功能,随访结果。结果克氏针组患者的手术时间、术中出血量、切口长度分别为(21.2±6.9)min、(26.98±2.94)mL、(3.28±0.35)cm,明显小于钢板组[(39.7±9.6)min、(30.65±3.28)mL、(5.19±0.54)cm],差异均有统计学意义(P<0.05)。克氏针组患者的骨折愈合时间与钢板组比较[(8.2±1.7)周vs.(8.6±2.1)周],差异无统计学意义(P>0.05)。术后7 d,克氏针组患者的血清NE、Cor、AT-Ⅱ水平分别为(238.92±25.71)ng/L、(154.87±17.54)nmol/L、(14.86±1.62)ng/mL,均低于钢板组[(254.73±27.09)ng/L、(167.49±18.53)nmol/L、(17.38±1.93)ng/mL],SOD水平高于钢板组[(152.65±17.35)nU/mL vs.(139.96±15.31)nU/mL],差异均有统计学意义(P<0.05)。克氏针组术后并发症发生率、拇指功能优良率与对照组比较(0 vs.10.71%、96.43%vs.92.86%),差异均无统计学意义(P>0.05)。2组患者均获得12个月随访,随访结果提示所有患者骨折均获解剖复位。结论克氏针或钢板内固定治疗第一掌骨基底部关节外骨折均可获得满意临床疗效,但克氏针较钢板内固定治疗手术时间较短,机体应激较小,安全性相对较高,且其内固定取出方便。Objective To compare the efficacy and stress level of Kirschner wire and steel plate in the treatment of extrararticular fracture of the base of the first metacarpal bone.Methods The clinical data of 56 patients with extraarticular fracture of the base of the first metacarpal bone treated in Bozhou Hospital of Traditional Chinese Medicine from June 2017 to June 2019 were retrospectively studied and divided into kirschner wire group(n=28)and steel plate group(n=28)according to the surgical method.Kirschner wire group received kirschner wire internal fixation and steel plate fixation.The operative time,intraoperative blood loss,incision length and fracture healing time were observed in both groups,preoperative and postoperative 7 d serum superoxide dismutase(SOD),cortisol(Cor),angiotensin-2(Ang-Ⅱ)and norepinephrine(NE)levels.postoperative complications and thumb function,results follow-up.Results The operation time,intraoperative blood loss,and incision length in the Kirschner wire group were(21.2±6.9)min,(26.98±2.94)mL,and(3.28±0.35)cm,respectively,which were significantly shorter than those in the steel plate group[(39.7±9.6)min,(30.65±3.28)mL,(5.19±0.54)cm],and the differences were statistically significant(P<0.05).There was no significant difference in fracture healing time between kirschner wire group and steel plate group[(8.2±1.7)weeks vs.(8.6±2.1)weeks](P>0.05).On the 7th postoperative day,the serum NE,Cor and Ang-Ⅱlevels in the Kirschner needle group were(238.92±25.71)ng/L,(154.87±17.54)nmol/L,and(14.86±1.62)ng/mL,respectively,which were all lower than In the plate group[(254.73±27.09)ng/L,(167.49±18.53)nmol/L,(17.38±1.93)ng/mL],the SOD level was higher than that in the plate group[(152.65±17.35)nU/mL vs.(139.96±15.31)nU/mL],the differences were statistically significant(P<0.05).There were no statistically significant differences in postoperative complication rate good and good thumb function ratein kirschner needles group compared with control group(10.71%vs.0),and good and good thumb

关 键 词：第一掌骨基底部骨折 克氏针 钢板 内固定 应激因子 

分 类 号：R687.3[医药卫生—骨科学]