单枚髓内针与交叉克氏针治疗青少年第五掌骨颈骨折的疗效比较  

Comparison of the rapeutic effects between single intramedullary nail and crossed K-wires in the treatment of fifth metacarpal neck fractures in adolescents

作　　者：李云隆 南国新 邝铭业 谢文冠 陈嘉辉 LI Yunlong;NAN Guoxin;KUANG Mingye;XIE Wenguan;CHEN Jiahui(Department of Pediatric Orthopedics,Dongguan Eighth People’s Hospital(Dongguan Children’s Hospital),Dongguan,Guangdong 523325,China;Department of Orthopedics Surgery,Dongguan Eighth People’s Hospital(Dongguan Children’s Hospital),Dongguan,Guangdong 523325,China)

机构地区：[1]东莞市第八人民医院(东莞市儿童医院)小儿骨科,广东东莞523325 [2]东莞市第八人民医院(东莞市儿童医院)骨外科,广东东莞523325

出　　处：《重庆医学》2023年第24期3746-3750,共5页Chongqing medicine

基　　金：广东省东莞市社会发展科技重点项目(20231800939922)。

摘　　要：目的比较单枚顺行髓内针与逆行交叉克氏针治疗青少年第五掌骨颈骨折的效果,以发现2种术式的优劣性。方法选取该院2014年1月至2023年6月诊断为第五掌骨颈骨折的31例青少年患者为研究对象,分为2组。髓内针组15例,采用单枚顺行弹性髓内针固定;克氏针组16例,采用逆行交叉克氏针固定。比较2组颈干角、手术时间、C臂使用次数、关节活动度(ROM)、疼痛视觉模拟量表(VAS)评分、上肢功能评定量表(DASH)评分、并发症等指标。结果髓内针组的手术时间和C臂使用次数少于克氏针组,取针时间大于克氏针组(P<0.05);2组术后即刻和骨折愈合时的颈干角均小于术前(P<0.05);术后1.5个月髓内针组患侧ROM大于克氏针组(P<0.05);2组术后3.0个月患侧ROM、VAS评分、DASH评分、并发症差异无统计学意义(P>0.05);2组术后3.0个月VAS评分均低于术后1.5个月(P<0.05)。结论单枚顺行髓内针与逆行交叉克氏针治疗青少年第五掌骨颈骨折后期均可获得满意的疗效,但单枚顺行髓内针较逆行交叉克氏针更容易置入,可缩短手术时间,减少C臂使用次数,早期对关节干扰更少。Objective To compare the efficacy of single antegrade intramedullary nail and retrograde crossed K-wires in the treatment of fifth metacarpal neck fractures in adolescents,and to discover the superiority and inferiority of the two surgical methods.Methods A total of 31 adolescent patients diagnosed with fifth metacarpal neck fracture from January 2014 to June 2023 in our hospital were selected and divided into two groups.In the intramedullary nail group,15 cases fixed with a single antegrade elastic intramedullary nail,and 16 cases in the K-wires group fixed with retrograde crossed K-wires.The two groups were compared in terms of neck shaftangle,duration of surgery,number of times the C-arm was used,range of motion(ROM),pain visual analogue scale(VAS) score,DASH score,and complications.Results The surgical time and the number of the C-arm was used in the intramedullary nail group were less than those in the K-wires group,and the time of pin removal was greater than that in the K-wires group(P<0.05);the neck shaft angle immediately after operation and at the time of fracture healing in both groups was smaller than that before operation(P<0.05);1.5 months after surgery,the ROM on the affected side of the intramedullary nail group was greater than that of the K-wires group(P<0.05);There was no statistically significant difference in ROM,VAS score,DASH score,and complications between the two groups3.0 months after operation(P>0.05);The VAS scores at 3.0 months after operation in both groups were lower than those at 1.5 months after operation.(P<0.05).Conclusion Both single antegrade intramedullary nail and retrograde crossed K-wires can obtain satisfactory curative results in the treatment of adolescent fifth metacarpal neck fractures in the later stage.However,single antegrade intramedullary nail is easier to insert than retrograde crossed K-wires,which can shorten the surgical time,reduce the time of C-arm uses,and have less early joint interference.

关 键 词：第五掌骨颈骨折 髓内针 克氏针 青少年 

分 类 号：R683.4[医药卫生—骨科学]