切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折的比较研究  

A comparative study of open reduction and hollow screws internal fixation versus closed reduction and percutaneous Kirschner wires internal fixation for treatment of Gedda typeⅠBennett fractures

作　　者：程省[1] 汤立新[1] 赵玉果[1] 马远[1] 王华磊[1] 叶向阳[1] 李显博 郭雄飞[1] CHENG Sheng;TANG Lixin;ZHAO Yuguo;MA Yuan;WANG Hualei;YE Xiangyang;LI Xianbo;GUO Xiongfei(Nanyang Central Hospital,Nanyang 473003,Henan,China)

机构地区：[1]南阳市中心医院,河南南阳473003

出　　处：《中医正骨》2021年第9期20-24,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折的临床疗效和安全性。方法:回顾性分析49例GeddaⅠ型Bennett骨折患者的病例资料,接受切开复位空心钉内固定治疗者24例(空心钉组),接受闭合复位经皮克氏针内固定治疗者25例(克氏针组)。比较2组患者的骨折愈合时间、术后并发症发生率,以及术后3个月、术后1年的上肢功能障碍(disabilities of the arm,shoulder and hand,DASH)评分和患手疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果:2组患者骨折愈合时间、术后3个月和术后1年患手疼痛VAS评分、术后1年DASH评分比较,组间差异均无统计学意义[(6.23±3.25)周,(5.56±2.27)周,t=0.816,P=0.419;(3.34±2.23)分,(2.25±2.55)分,t=1.562,P=0.125;(1.21±1.03)分,(1.08±1.98)分,t=0.284,P=0.778;(8.21±2.32)分,(9.30±3.74)分,t=1.206,P=0.234];术后3个月空心钉组的DASH评分低于克氏针组[(15.32±3.23)分,(25.25±7.81)分,t=5.740,P=0.000]。空心钉组术后并发局部皮肤感觉异常2例(1例为麻木,1例为刺痛),均未行特殊处理,末次随访时症状有所改善。克氏针组术后并发克氏针松动、复位丢失2例,再次行闭合复位克氏针内固定手术后骨折愈合;并发针道感染1例,抗感染治疗后感染控制,骨折愈合后去除克氏针。均无骨折延迟愈合、不愈合、畸形愈合及神经、血管损伤等并发症发生。2组患者并发症发生率的差异无统计学意义(χ^(2)=0.000,P=1.000)。结论:切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折,二者在缓解患手疼痛、促进骨折愈合方面疗效相当,且安全性相当,但前者在促进术后早期上肢功能恢复方面有优势。Objective:To compare the clinical curative effects and safety of open reduction and hollow screws internal fixation versus closed reduction and percutaneous Kirschner-wires(K-wires)internal fixation in treatment of Gedda typeⅠBennett fractures.Methods:The medical records of 49 patients with Gedda typeⅠBennett fractures were analyzed retrospectively.Twenty-four patients were treated with open reduction and hollow screws internal fixation(hollow screw group),while the others with closed reduction and percutaneous K-wires internal fixation(K-wire group).The fracture healing time,postoperative complication incidence,disabilities of the arm,shoulder and hand(DASH)scores and injured hand pain visual analogue scale(VAS)scores at 3 and 12 months after the surgery were compared between the 2 groups.Results:There was no statistical difference in fracture healing time,injured hand pain VAS scores at 3 and 12 months after the surgery and DASH scores at 12 months after the surgery between the 2 groups(6.23±3.25 vs 5.56±2.27 weeks,t=0.816,P=0.419;3.34±2.23 vs 2.25±2.55 points,t=1.562,P=0.125;1.21±1.03 vs 1.08±1.98 points,t=0.284,P=0.778;8.21±2.32 vs 9.30±3.74 points,t=1.206,P=0.234).The DASH scores were lower in hollow screw group compared to K-wire group at 3 months after the surgery(15.32±3.23 vs 25.25±7.81 points,t=5.740,P=0.000).The postoperative local skin paresthesia,manifesting as numbness in 1 patient and stabbing pain in 1 patient,were found in hollow screw group,and the symptoms improved spontaneously at last follow-up without any special treatment.The postoperative K-wires loosening and fracture reduction loss(2 cases)as well as pin hole infection(1 case)were found in K-wire group.The fractures healed after closed reduction and percutaneous K-wires internal fixation,and the infection was controlled after anti-infection treatment and the K-wires were removed after fracture healing.No complications such as fracture delayed union,fracture nonunion,fracture malunion and neurovascular injury were found in t

关 键 词：骨折固定术 内 骨螺丝 克氏针 治疗结果 BENNETT骨折 

分 类 号：R687.3[医药卫生—骨科学]