双平面V形截骨治疗陈旧性第五掌骨颈骨折  

Biplane V-shaped osteotomy for the treatment of the fifth metacarpal neck old fracture

作　　者：郑加法[1] 李宏志[1] 李荣俊[1] 齐志明 Zheng Jiafa;Li Hongzhi;Li Rongjun;Qi Zhiming(Department of Orthopedics,Dalian Second People′s Hospital,Dalian 116011,China)

机构地区：[1]大连市第二人民医院骨科,大连116011

出　　处：《中华手外科杂志》2023年第2期108-111,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨双平面V形截骨治疗陈旧性第五掌骨颈骨折的疗效。方法我院自2016年1月至2020年12月收治12例陈旧性第五掌骨颈骨折患者,利用双平面V形截骨纠正成角畸形及短缩畸形,尺骨鹰嘴处取骨局部植骨钢板内固定。根据术后影像学结果及中华医学会手外科学会手指关节总活动度系统评定方法评估手术效果。结果所有患者术后随访10~15个月,平均12.6个月。切口均Ⅰ期愈合,无并发症。术后CT显示第五掌骨矢状面头干角(9.33±1.82)°、冠状面头干角(5.58±1.83)°与术前(52.33±6.44)°、(29.83±3.71)°相比均有所改善,差异有统计学意义(P<0.05);与健侧(9.17±1.75)°、(5.75±2.09)°相比,差异无统计学意义(P>0.05)。四五掌骨相对长度差由术前(9.18±1.62)mm缩短到术后(5.27±0.38)mm,差异有统计学意义(P<0.05);与健侧(5.48±0.43)mm相比,差异无统计学意义(P>0.05)。末次随访时第五掌指关节主动活动范围(86.75±2.56)°(82°~90°),较术前(50.00±6.05)°(42°~60°)明显增大,差异有统计学意义(P<0.05);与健侧(88.50±2.39)°(85°~92°)相比,差异无统计学意义(P>0.05)。手指关节总活动度系统评定均为优。结论双平面V形截骨治疗陈旧性第五掌骨颈骨折,可矫正矢状面及冠状面成角畸形,恢复掌骨长度,术后功能恢复满意。Objective To explorethe clinical efficacy of biplane V-shaped osteotomy in the treatment of the fifth metacarpal neck old fracture.Methods From January 2016 to December 2020,12 patients with old fracture of the fifth metacarpal neck were treated in our hospital.Biplane V-shaped osteotomy was used to correct angulation and shortening deformity,and the olecranon of ulna was taken out and locally implanted with bone following internal fixation by plate.The clinical efficacy of surgery was evaluated according to the postoperative imaging results and the systematic evaluation method of total range of motion of finger joint issued by Hand Surgery Society of Chinese Medical Association.Results All the patients were follow-up for 10 to 15 months,with an average of 12.6 months.All the incisions achieved primary healing without complications.The postoperative CT showed that the sagittal head and shaft angle(9.33±1.82)°and coronal head andshaft angle(5.58±1.83)°of the fifth metacarpal bone were improved compared with those before operation(52.33±6.44)°and(29.83±3.71)°with statistically significant difference(P<0.05).Compared with the healthy side(9.17±1.75)°,(5.75±2.09)°,the difference was not statistically significant(P>0.05).The relative length difference of the fourth and fifth metacarpals was shortened from(9.18±1.62)mm before operation to(5.27±0.38)mm after operation,and the difference was statistically significant(P<0.05).Compared with the healthy side(5.48±0.43)mm,the difference was not statistically significant(P>0.05).At the last follow-up,the active range of motion of the fifth metacarpophalangeal joint was(86.75±2.56)°(82°to 90°),which was significantly larger than that before operation(50.00±6.05)°(42°to 60°)(P<0.05).Compared with the healthy side(88.50±2.39)°(85°to 92°),the difference was not statistically significant(P>0.05).The total range of motion of finger joint was evaluated as excellent.Conclusion The biplane V-shaped osteotomy in the treatment of the fifth metacarpal neck old

关 键 词：掌骨 骨折 陈旧性 畸形矫正 

分 类 号：R687.3[医药卫生—骨科学]