克氏针扣压结合经骨固定治疗掌骨头撕脱骨折疗效观察  

Effectiveness on treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation

作　　者：杨焕友[1] 王斌[1] 黄蕾 郭琳[1] 刘志旺[1] 李红 苗建梅 YANG Huanyou;WANG Bin;HUANG Lei;GUO Lin;LIU Zhiwang;LI Hong;MIAO Jianmei(The First Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China)

机构地区：[1]唐山市第二医院手一科,河北唐山063000

出　　处：《中国修复重建外科杂志》2023年第11期1390-1393,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结克氏针扣压结合经骨固定治疗掌骨头撕脱骨折的疗效。方法回顾分析2017年3月—2022年6月收治且符合选择标准的35例掌骨头撕脱骨折患者临床资料。男22例,女13例;年龄20~55岁,平均31.6岁。损伤部位:第2掌骨头撕脱骨折17例,第4掌骨头撕脱骨折6例,第5掌骨头撕脱骨折12例。致伤原因:绞伤21例,扭伤8例,运动损伤6例。X线片检查示掌骨头撕脱骨折块大小范围为0.30 cm×0.20 cm~0.55 cm×0.45 cm。术前伤指总活动度(total active motion,TAM)为(154.00±17.38)°。受伤至手术时间3~10 d,平均5.8 d。术后定期随访,行X线片、CT检查评估骨折愈合情况,并测量伤指TAM;采用中华医学会手外科学会上肢部分功能评定试用标准评价手指功能。结果术后切口均Ⅰ期愈合。35例患者均获随访,随访时间9~36个月,平均28个月。掌骨头撕脱骨折均达骨性愈合,愈合时间4~6周,平均4.8周。患者掌指关节稳定,无僵硬,屈伸活动良好。末次随访时,伤指TAM达(261.88±6.23)°,与术前比较差异有统计学意义(t=-35.351,P<0.001)。按中华医学会手外科学会上肢部分功能评定试用标准评定手指功能,获优33例、良2例,优良率100%。结论克氏针扣压结合经骨固定治疗掌骨头撕脱骨折具有创伤小、固定牢靠、对掌指关节周围软组织干扰少等优点,是一种可选择的较好方法。Objective To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture.Methods The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed.There were 22 males and 13 females;the age ranged from 20 to 55 years,with an average of 31.6 years.There were 17 cases of the second metacarpal avulsion fracture,6 cases of the fourth metacarpal avulsion fracture,and 12 cases of the fifth metacarpal avulsion fracture.The causes of injury included 21 cases of strangulation,8 cases of sprain,and 6 cases of sports injury.X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm.The total active motion(TAM)of the injured finger before operation was(154.00±17.38)°.The time from injury to operation was 3-10 days,with an average of 5.8 days.Follow-up regularly after operation,X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured.The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association.Results All the incisions healed by first intention.All 35 patients were followed up 9-36 months,with an average of 28 months.All metacarpal avulsion fractures achieved bony healing,and the healing time was 4-6 weeks,with an average of 4.8 weeks.The metacarpophalangeal joint of the patient was stable,without stiffness,and the flexion and extension activities were good.At last follow-up,the TAM of the injured finger reached(261.88±6.23)°,which was significantly different from that before operation(t=−35.351,P<0.001).The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association,and 33 cases were excellent and 2 cases were good,with an excellent and good rate of 100%.Conclusion The

关 键 词：掌骨头撕脱骨折 克氏针 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]