不同方式治疗第5掌骨颈骨折的疗效比较  

Comparison of the curative effect of different treatment methods for the fifth metacarpal neck fracture

作　　者：吴磊 田茂生 钱宇斐 WU Lei;TIAN Maosheng;QIAN Yufei(Department of Surgery,Tianjin Armed Police Corps Hospital,Tianjin,300252,China)

机构地区：[1]武警天津市总队医院外科 [2]天津市河北区建昌社区卫生服务中心中医科,天津300252

出　　处：《实用手外科杂志》2021年第2期185-187,共3页Journal of Practical Hand Surgery

摘　　要：目的对比分析三种不同手术方式治疗第5掌骨颈骨折的临床疗效。方法选取2017年3月-2020年1月接受经皮克氏针交叉固定、顺行髓内针固定及微型钢板固定三种手术方式治疗的第5掌骨颈骨折病例61例,分为A组24例(经皮克氏针交叉固定)、B组21例(顺行髓内针固定)、C组16例(微型钢板内固定)。对三组手术时间、术后掌指关节活动度及第5掌骨头干角进行两两比较评估。结果所有患者均获得随访,随访时间3~18个月,平均(7.5±2.31)个月。手术时间比较:A组用时最短且与C组比较差异有统计学意义(P<0.05)。掌指关节活动度比较:第一次随访(术后1个月)时A组最差,与其余两组比较差异有统计学意义(P<0.05);末次随访时A组最好且与C组比较差异有统计学意义(P<0.05)。三组头干角比较:结果无统计学意义(P>0.05)。结论在第5掌骨颈骨折的手术治疗中,闭合复位经皮克氏针交叉固定的手术方式虽然在早期存在掌指关节活动度差的不足,但经过功能训练,后期关节功能恢复良好,且有手术时间短、术中损伤小、术后无需二次切开取出内固定物及手术费用低等优点,值得临床采用。Objective To compare and analyze the clinical effect of three different surgical methods in the treatment of the fifth metacarpal neck fracture.Methods From March 2017 to January 2020,61 patients with fracture of the fifth metacarpal neck were treated by percutaneous Kirschner wire cross fixation,antegrade intramedullary nailing and mini plate fixation.They were divided into group A(24 cases with percutaneous Kirschner wire cross fixation),group B(21 cases with antegrade intramedullary nail fixation)and group C(16 cases with micro plate).The operation time,the range of motion of metacarpophalangeal joint and the angle of the fifth metacarpal head were compared among three groups.Results All patients were followed up for 3 to 18 months(mean 7.5±2.31 months).The operation time of group A was the shortest and the difference was statistically significant(P<0.05).The results of comparison of metacarpophalangeal joint range of motion:the first follow-up(1 month after operation)in group A was the worst,and the difference was statistically significant(P<0.05);at the last follow-up,group A was the best and the difference was statistically significant(P<0.05).There was no significant difference between three groups(P>0.05).Conclusion In the surgical treatment of the fifth metacarpal neck fracture,the closed reduction and cross fixation with percutaneous Kirschner wire has the disadvantages of poor metacarpophalangeal joint mobility in the early stage,but after functional exercise,the joint function recovers well in the later stage,and has the advantages of short operation time,small intraoperative injury,no need to open the internal fixator again after operation and low operation cost,which is worthy of clinical application.

关 键 词：第5掌骨颈骨折 克氏针交叉固定 顺行髓内针固定 微型钢板内固定 

分 类 号：R687.3[医药卫生—骨科学]