C型臂下闭合复位克氏针内固定治疗第一掌骨基底部骨折

发布时间：2018-03-03 09:30

  本文选题：第一掌骨基底部骨折　切入点：闭合复位　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的： 手是一个特别复杂的器官，在人们的日常生产生活中起着重要作用。手部最为重要的第一腕掌关节由第一掌骨基底与大多角骨组成，形成特有的鞍状关节，该关节在拇指的外展、对掌活动中起着重要的作用。而第一掌骨基底部骨折在手部骨与关节损伤中比较常见，且该骨折破坏第一腕掌关节，造成不稳定型骨折，由于第一腕掌关节的特殊解剖结构，骨折临床分型较多，治疗方法多种，疗效不一，如果治疗不当可导致骨折畸形愈合，晚期导致并发创伤性关节炎，严重影响拇指外展、对掌活动，进而影响手部功能，因此选择一种操作简单、固定可靠、疗效优良的方法治疗第一掌骨基底部骨折极其重要，也是临床医生积极探求的课题。本文就C型臂下闭合复位克氏针内固定治疗第一掌骨基底部骨折的临床疗效进行探讨。 资料与方法: 本文研究的病例均采集于吉林大学中日联谊医院手外科门诊及病房2012年9月～2015年1月符合入选标准的病例，均采用C型臂透视下闭合复位克氏针内固定、石膏托外固定治疗的19例第一掌骨基底部骨折病例的临床资料进行分析。其中男11例，女8例；年龄27～65岁，平均39.5岁。伤后至手术时间1.5h～3d，平均10.3h。骨折根据Green分型：Ⅰ型Bennett骨折2例，Ⅲ型成人关节外骨折17例。术后对患者进行随访，分别采用：①TAM系统评定法来评价手指主动活动度及骨折愈合情况；②采用S lgeback等方法评定患者主观感受情况；③应用量角器测量第一腕掌关节屈伸活动度及拇指屈伸活动度（ROM）及用Jamar测力计测量握力，并与健侧比较。 结果： 手术时间15-45min,平均30min；术后住院时间1-3d。术后患者均获随访，，随访时间6～12周，平均6.5周：19例，患者骨折均获骨性愈合，愈合时间为4～6周，平均5.5周。依据TAM系统评定法及患者主观感受情况14例优，4例良，1例中，优良率94.7%。其中1例发生针道感染，2例发生克氏针略松动。第一腕掌关节屈伸活动度及拇指屈伸活动度（ROM）及握力与健侧比较，无明显差异。 结论： C型臂下闭合复位克氏针内固定治疗第一掌骨基底部骨折具有操作简单、复位满意、固定可靠、骨折愈合时间短，早期实现功能锻炼，有效降低术后关节疼痛、关节活动受限和创伤性关节炎的发生率，临床疗效满意，适合临床推广应用。 该术式具有以下特点：①操作简便，无手术切口，对局部皮肤血运无影响,减少术后感染机会。②不剥离骨膜、不破坏骨折端血运及关节囊的完整性，有利于骨折愈合。③降低肌腱粘连、关节挛缩机会。④一般术后3天即可出院,缩短住院日。⑤随访及拆除固定物均可在门诊完成，避免二次损伤。⑥克氏针价格便宜,减轻了患者的经济负担和精神负担。⑦对于伴随其他疾病（心脏病、高血压、糖尿病等）的患者,大大减少了手术风险。
[Abstract]:Background and objectives:. The hand is a particularly complex organ that plays an important role in people's daily life. The most important first carpometacarpal joint of the hand consists of the base of the first metacarpal bone and most of the horn bones, forming a unique saddle joint. The joint plays an important role in the metacarpal movement, and the fracture of the base of the first metacarpal bone is more common in the injuries of the hand bone and joint, and the fracture destroys the first metacarpal joint and causes unstable fracture. Because of the special anatomical structure of the first carpometacarpal joint, the fracture has many clinical types, many treatment methods and different curative effects. If the treatment is improper, it can lead to the fracture malunion, the late stage leads to traumatic arthritis, which seriously affects the abduction of the thumb. Therefore, it is very important to choose a simple, reliable and effective method to treat the fracture of the base of the first metacarpal bone. This paper discusses the clinical effect of closed reduction with Kirschner needle in the treatment of the first metacarpal base fracture. Information and methods:. All the cases were collected from hand surgery outpatient department and ward of Sino-Japanese Friendship Hospital of Jilin University from September 2012 to January 2015. All the patients were treated with closed reduction and Kirschner needle internal fixation under C-arm fluoroscopy. The clinical data of 19 cases of first metacarpal base fracture treated by plaster external fixation were analyzed. The average age was 39.5 years. The average time from injury to operation was 1.5 hours to 3 days, with an average of 10.3 hours. According to Green classification, there were 2 cases of type 鈪

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