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作 者:董惠双[1] 臧砚超 马铁鹏[1] 高顺红[1] 张文龙[1] 于志亮[1] 张云鹏[1] 姚军[1] 李军[1] DONG Huishuang;ZANG Yanchao;MA Tiepeng(Department of Hand Surgery,The Second Hospital of Tangshan,Hebei,063000,China)
出 处:《实用手外科杂志》2021年第2期158-160,163,共4页Journal of Practical Hand Surgery
摘 要:目的探讨腕大多角骨闭合性骨折的治疗方法及手术疗效。方法2014年6月-2017年9月,应用有限切开克氏针内固定治疗4例腕大多角骨闭合性骨折,按Walker's分型:Ⅱ型:桡侧劈裂骨折1例;Ⅳ型:轴向骨折2例;Ⅴ型:粉碎性骨折1例。术后予拇指人字支具固定保护4~6周,去支具功能训练,术后8~10周根据骨折愈合情况去除固定克氏针。根据术后拇指活动疼痛程度、捏力、关节的活动度等方面评价手术疗效。结果术后4例均获得随访,随访时间6~25个月,平均14.8个月,骨折愈合时间(6.5±0.8)(6~8)周,拇指活动正常,捏力正常,拇指背侧感觉正常。未发生克氏针松动折断、针道感染及桡神经浅支损伤等并发症。末次随访时,患侧拇指TAM(172.9°±5.8°)(169°~179°),健侧拇指TAM(179.5°±3.8°)(171°~180°);患侧捏力(12.2±1.5)(10~13)kg,健侧捏力(12.8±1.1)(10~14)kg;患侧握力(36.3±4.3)(32~41)kg,健侧握力(34.6±4.1)(29~40)kg。双侧TAM和握力、捏力差异均无统计学意义(P>0.05)。VAS评分(0.5±0.8)(0~2)分,Mayo腕关节评分(96.5±4.5)(91~100)分。结论有限切开克氏针内固定治疗腕大多角骨闭合性骨折,具有操作简便、固定确切、疗效满意等优点,可在临床推广应用。Objective To investigate the treatment and operations outcome of closed isolated fracture of trapezium.Methods From June 2014 to September 2017,4 patients with closed isolated fracture of trapezium were treated with limited open reduction combined with K-wires internal fixation.According to the classification of trapezium fracture of Walker et al criteria,it included one case of typeⅡ,two cases of typeⅣ,and one case of typeⅤ.Short arm spica cast fixation was needed for 4-6 weeks after operation,and then the plaster was decided to be removed or not according to the healing condition of trapezium fracture.Exercisement of the injured thumb was taken 8-10 weeks after operation gradually.The postoperative curative efficacy was assessed by the degree of pain suffered while the thumb moved normally,pinch force and range of motion.Results All the patients were followed up for 6-25months(mean 15.5 months).Healing time of fracture were 6.5±0.8(6-8)weeks.The activity,pinch force and the sensation of dorsum of thumb were normal,no complications of K-wire loose and break,pin site infection and injury of superficial radial nerve occured.At the last time of followed-up,the TAM of the injured side of thumb was 172.9°±5.8°(169°~179°),while the TAM was 179.5°±3.8°(171°~180°)in the health side;the pinch force of the injured side was 12.2±1.5(10~13)kg,while the health side was 12.8±1.1(10~14)kg;the grip force of injured side was 36.3±4.3(32~41)kg,while the health side was 34.6±4.1(29~40)kg.There was no remarkable difierence between them(P>0.05).The score of VAS was 0.5±0.8(0~2).According to Mayo wrist criteria for functional assessment,the score was 96.5±4.5(91~100).Conclusion Limited open reduction combined with K-wires internal fixation on the treatment of isolated trapezium has the advantages of simple operation,satisfactory affect and exact fixation.It is worthy of clinical promotion and application.
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