顺行克氏针髓内固定治疗青少年第五掌骨颈骨折的临床应用  

Clinical application of antegrade Kirschner wire intramedullary fixation in the treatment of adolescent fifth metacarpal neck fracture

作　　者：樊晓磊 王健[2] 张德华[2] 毛峰[2] 廖燚[2] Fan Xiaolei;Wang Jian;Zhang Dehua;Mao Feng;Liao Yi(Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Orthopedics,Karamay Central Hospital,Xinjiang 834000,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]克拉玛依市中心医院骨科,新疆834000

出　　处：《中华手外科杂志》2021年第2期87-90,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨顺行克氏针髓内固定治疗青少年第五掌骨颈骨折的临床疗效。方法自2017年5月至2019年10月,我们采用闭合复位、经皮顺行克氏针髓内固定治疗11例明显移位的青少年第五掌骨颈骨折。术后随访患侧、健侧第五掌骨头干角、掌指关节主动活动度、疼痛视觉模拟评分(visual analogue scale,VAS)、抓握力量等,并进行统计学分析,评价手术疗效及功能恢复情况。结果术后随访时间为12~24个月,平均17.1个月,所有骨折均达到解剖复位,骨折愈合时间为2~4个月,平均(2.8±1.1)个月。患侧第五掌骨背侧成角畸形从术前(44.5±2.6)°显著降至术后(15.7±2.5)°(P<0.001)。术后第五掌骨掌指关节主动活动度,患侧(87.9±2.4)°与健侧(88.5±2.4)°比较差异无统计学意义(P=0.084)。术后VAS为0~2分,平均(0.18±0.60)分。患侧抓握力为健侧的85%~101%,平均(91.5±4.5)%。所有患者均未出现骨折不愈合、移位、功能障碍、畸形以及掌骨头坏死。本组中1例患者出现骨骺板提前闭合,但未发生肢体短缩和成角畸形。结论顺行克氏针髓内固定方法治疗青少年第五掌骨颈骨折,术后功能和外形恢复良好,是一种可靠的手术方式。该术式虽存在潜在的生长板损伤风险,对于骨骺板接近闭合的青少年患者是较好的选择。Objective To investigate the clinical efficacy of antegrade Kirschner wire intramedullary fixation in the treatment of adolescent fifth metacarpal neck fracture.Methods From May 2017 to October 2019,11 cases of obviously displaced fifth metacarpal neck fractures in adolescents were treated by close reduction and percutaneous antegrade Kirschner wire intramedullary fixation.Postoperative follow-up included the affected and uninjured fifth metacarpal head-trunk angle,active range of motion of metacarpophalangeal joint,visual analogue scale(VAS)of pain,grip strength,etc.,and statistical analysis was performed to evaluate the surgical efficacy and functional recovery.Results The follow-up time was 12 to 24 months with an average of 17.1 months.All the fractures achieved anatomical reduction.The fracture healing time was 2 to 4 months with an average of(2.8±1.1)months.The incidence of the fifth dorsal metacarpal angulation decreased from(44.5±2.6)°preoperatively to(15.7±2.5)°postoperatively(P<0.001).There was no significant difference in the active range of motion of the fifth metacarpal metacarpophalangeal joint between the affected side(87.9±2.4)°and the healthy side(88.5±2.4)°(P=0.084).Postoperative VAS was 0 to 2 with an average of(0.18±0.60).The grip strength of the affected side was 85%to 101%of that of the healthy side,with an average of(91.5±4.5)%.There was no nonunion,displacement,dysfunction,deformity and metacarpal head necrosis in all patients.In this group,one patient had early closure of epiphyseal plate,but no limb shortening and angulation.Conclusion The antegrade Kirschner wire intramedullary fixation is a reliable method for the treatment of adolescent fifth metacarpal neck fracture,with good postoperative recovery of function and appearance.Although there is a potential risk of growth plate injury,it is a better choice for adolescent patients with epiphyseal plate close to closure.

关 键 词：青少年 骨折固定术 髓内 掌骨颈骨折 骺板早闭 克氏针 

分 类 号：R687.3[医药卫生—骨科学]