微创小切口治疗闭合掌骨干骨折  

Minimally invasive incision for the treatment of metacarpal shaft fractures

作　　者：姚懿伦 杨蓊勃[1] Yao Yilun;Yang Wengbo(Department of Orthopedic Surgery,Nanjing Hospital,Nanjing First Hospital,Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)骨科,南京210000

出　　处：《中华手外科杂志》2023年第6期497-499,共3页Chinese Journal of Hand Surgery

摘　　要：目的报告利用微创小切口治疗闭合掌骨干骨折的临床疗效。方法自2018年9月至2021年8月,我们采用微创小切口,结合1.5 mm锁定加压接骨板(locking compression plate,LCP)接骨板治疗闭合掌骨干骨折患者21例,术后进行早期功能锻炼。分别于术后4、12、24周复查X线片,评估骨折愈合情况,并测量患者健侧与患侧主动关节活动范围(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)及手指捏握力量。末次随访采用手指总主动活动度(total active motion,TAM)法评定功能。结果术后随访时间为12~30个月,平均(19.3±3.1)个月,所有骨折均达到解剖复位,骨折愈合时间为2~4个月,平均(2.4±1.3)个月。术后掌指关节ROM,患侧(87.3±2.6)°与健侧(88.7±2.5)°比较,差异无统计学意义(P=0.018)。术后VAS为0~2分,平均(0.17±0.80)分。患侧手指捏握力为健侧的86%~101%,平均(90.8±3.1)%。末次随访手指关节TAM评分:优17例,良3例,中1例。所有患者均未出现骨折不愈合、移位、功能障碍、畸形等。结论微创小切口治疗闭合掌骨干骨折,对周围软组织损伤小,骨折愈合良好。术后功能和外形恢复良好,瘢痕较小,内固定取出方便。Objective To report the clinical efficacy of using minimally invasive incision for the treatment of metacarpal shaft fractures.Methods From September 2018 to August 2021,21 patients with closed metacarpal shaft fractures were treated through a minimally invasive incision combined with a 1.5 mm locking compression plate(LCP)plate.Early postoperative functional exercise was performed.X-ray films were re-examined at 4,12,and 24 weeks postoperatively to evaluate fracture healing,and active joint range of motion(ROM),visual analog scale(VAS)of pain,and finger grip strength were measured on the healthy and affected sides of the patient.At the last follow-up,the total active motion(TAM)method was used to assess finger function.Results The postoperative follow-up time was 12 to 30 months,with an average of(19.3±3.1)months.All fractures achieved anatomical reduction,and the fracture healing time was 2 to 4 months,with an average of(2.4±1.3)months.After surgery,there was no statistically significant difference in ROM between the affected side(87.3±2.6)°and the healthy side(88.7±2.5)°(P=0.018).The postoperative VAS was 0 to 2 points,with an average of(0.17±0.80)points.The grip strength of the affected side′s fingers was 86%to 101%of that of the healthy side,with an average of(90.8±3.1)%.At the last follow-up,the TAM score of the finger joint was excellent in 17 cases,good in 3 cases,and moderate in 1 case.None of the patients had fracture nonunion,displacement,dysfunction,deformity,etc.Conclusion The treatment for closed metacarpal shaft fractures through minimally invasive incision has minimal damage to surrounding soft tissues and good fracture healing.The postoperative function and appearance recovered well,with small scars and convenient removal of internal fixation.

关 键 词：掌骨 骨折 骨折固定术 内 微创切口 锁定加压钢板 

分 类 号：R687.3[医药卫生—骨科学]