闭合复位全螺纹空心加压螺钉内固定与切开复位钢板螺钉内固定治疗Bennett骨折的对比研究  

A comparative study of closed reduction and full-thread hollow compression screws internal fixation versus open reduction and plate-screws internal fixation for treatment of Bennett fractures

作　　者：林勇 罗伟斌 叶前驱 曾广辉 阮张涛 曾秋涛 周驰[2] LIN Yong;LUW eibin;YE Qianqu;ZENG Guanghui;RUAN Zhangtao;ZENG Qiutao;ZHOU Chi(The Third Afiliated Hospital of Guangdong Medical University(Shunde Longjiang Hospital),Foshan 528318,Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China)

机构地区：[1]广东医科大学附属第三医院/佛山市顺德区龙江医院,广东佛山528318 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《中医正骨》2022年第1期41-46,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：佛山市医学类科技攻关项目(2018AB002023)。

摘　　要：目的:比较闭合复位全螺纹空心加压螺钉内固定与切开复位钢板螺钉内固定治疗Bennett骨折的临床疗效及安全性。方法:回顾性分析2015年1月至2020年1月收治的43例Bennett骨折患者的病例资料,采用闭合复位全螺纹空心加压螺钉内固定治疗者20例(空心加压螺钉组),采用切开复位钢板螺钉内固定治疗者23例(钢板螺钉组)。比较两组患者的手术时间、术中出血量、骨折愈合时间、采用拇指功能评价标准评价的患侧拇指功能、采用Hotchkiss骨折与关节移位标准评价的第一腕掌关节面恢复情况、采用上肢功能障碍(disabilities of the arm,shoulder and hand,DASH)评分标准评价的综合疗效以及并发症发生情况。结果:①一般指标。2组患者手术时间、术中出血量及骨折愈合时间比较,组间差异均无统计学意义[(39.30±5.63)min,(38.87±5.00)min,t=0.266,P=0.792;(30.85±4.71)mL,(29.91±5.49)mL,t=0.596,P=0.554;(6.95±1.43)周,(7.04±1.36)周,t=-0.219,P=0.828]。②拇指功能。术后6个月,空心加压螺钉组的拇指功能优16例、良3例、差1例,钢板螺钉组的拇指功能优11例、良9例、差3例,空心加压螺钉组的拇指功能优于钢板螺钉组(Z=-2.108,P=0.035)。③第一腕掌关节面恢复情况。术后12个月,空心加压螺钉组的第一腕掌关节面恢复情况优17例、良2例、差1例,钢板螺钉组的第一腕掌关节面恢复情况优12例、良9例、差2例,空心加压螺钉组的第一腕掌关节面恢复情况优于钢板螺钉组(Z=-2.161,P=0.031)。④DASH评分。时间因素与分组因素不存在交互效应(F=2.198,P=0.118)。2组患者DASH评分总体比较,组间差异无统计学意义,即不存在分组效应(F=-1.607,P=0.110)。手术前后不同时间点DASH评分的差异有统计学意义,即存在时间效应(F=14.001,P=0.001)。2组DASH评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致。术前2组患者DASH评分比较,差异无统计学意义[(71.45±Objective: To compare the clinical curative effects and safety of closed reduction and full-thread hollow compression screws(HCSs) internal fixation versus open reduction and plate-screws(PSs) internal fixation in treatment of Bennett fractures. Methods:The medical records of 43 patients with Bennett fractures recruited from January 2015 to January 2020 were analyzed retrospectively. Twenty patients were treated with closed reduction and full-thread HCSs internal fixation(HCSs group) and 23 ones with open reduction and PSs internal fixation(PSs group). The operative time,intraoperative blood loss,fracture healing time,function of the injuried thumb evaluated by using thumb function evaluation criteria,recovery of the first carpometacarpal(CMC-1) joint surface assessed by using Hotchkiss fracture and joint displacement criteria,the total clinical curative effects evaluated by using disabilities of the arm,shoulder and hand(DASH) scoring criterion and postoperative complication incidence were compared between the 2 groups. Results:(1)There was no statistical difference in operative time,intraoperative blood loss and fracture healing time between the 2 groups(39. 30 ± 5. 63 vs 38. 87 ± 5. 00 minutes,t =0. 266,P = 0. 792;30. 85 ± 4. 71 vs 29. 91 ± 5. 49 m L,t = 0. 596,P = 0. 554;6. 95 ± 1. 43 vs 7. 04 ± 1. 36 weeks,t =-0. 219,P =0. 828).(2)The function of the injuried thumbs was evaluated at 6 months after the surgery,and 16 patients obtained an excellent result,3 good and 1 poor in HCSs group;while 11 ones obtained an excellent result,9 good and 3 poor in PSs group. The thumb function was better in HCSs group compared to PSs group(Z =-2. 108,P = 0. 035).(3)The recovery of the CMC-1 joint surfaces was assessed at 12 months after the surgery,and 17 patients obtained an excellent result,2 good and 1 poor in HCSs group;while 12 ones obtained an excellent result,9 good and 2 poor in PSs group. The recovery of the CMC-1 joint surfaces was better in HCSs group compared to PSs group(Z =-2. 161,P = 0. 031).(4)There was

关 键 词：掌骨 腕掌关节 骨折脱位 骨折固定术 内 骨螺丝 BENNETT骨折 临床试验 

分 类 号：R687.3[医药卫生—骨科学]