陈旧性第一掌骨基底部骨折脱位的手术治疗

发布时间：2018-05-21 18:56

本文选题：第掌骨基底部骨折脱位 + 桡背侧韧带　；参考：《中国修复重建外科杂志》2017年06期

【摘要】：目的总结手术治疗陈旧性第1掌骨基底部骨折脱位(Bennett骨折)疗效。方法 2012年2月—2015年3月,采用韧带松解联合克氏针固定方法治疗10例陈旧性Bennett骨折患者。其中男8例,女2例;年龄24~44岁,平均35.3岁。伤后至手术时间为5~14周,平均7.5周。术前拇示指捏力为1~3级,平均1.8级。术后石膏外固定4~8周,骨折愈合后去除克氏针,期间在康复师指导下进行功能锻炼。结果术后切口均Ⅰ期愈合。10例均获随访,随访时间7~16个月,平均12.5个月。X线片及CT检查示第1腕掌关节对位好,无再脱位发生;骨折均愈合,愈合时间2~4个月,平均3.5个月。1例伤后14周手术患者,术后第1腕掌关节仍存在持续疼痛症状,X线片检查见关节毛糙、间隙变窄,证实第1腕掌关节炎形成;其余患者无关节炎发生,第1腕掌关节处无明显疼痛,关节稳定。末次随访时,拇示指捏力为3~12级,平均6.8级。根据手指关节总活动度(TAM)系统评定方法评价疗效,优7例,良2例,差1例,优良率90%。结论对于陈旧性Bennett骨折,通过适当松解桡背侧韧带联合克氏针内固定治疗,可取得良好疗效。
[Abstract]:Objective to summarize the effect of surgical treatment of old first metacarpal base fracture and dislocation (Bennett fracture). Methods from February 2012 to March 2015, 10 patients with old Bennett fractures were treated with ligamentolysis combined with Kirschner's needle fixation. There were 8 males and 2 females, aged 2444 years with an average age of 35.3 years. The time from injury to operation was 5 ~ 14 weeks with an average of 7.5 weeks. Preoperative thumb finger pinch force was 1 ~ 3 grade, average 1.8 grade. After 4 weeks of external plaster fixation, Kirschner needle was removed after fracture healing, and functional exercise was carried out under the guidance of the rehabilitator. Results all the patients were followed up for 7 ~ 16 months (mean 12.5 months) and CT examination showed that the first carpal metacarpal joint had no redislocation, and the fracture healed for 2 ~ 4 months. In an average of 3.5 months, there were still persistent pain symptoms in the first wrist metacarpal joint. X-ray examination showed that the joint was rough and the gap narrowed, which confirmed the formation of the first wrist metacarpal arthritis, and no arthritis occurred in the other patients. There was no obvious pain in the first wrist-metacarpal joint and the joint was stable. At the last follow-up, the pinch force of thumb finger was 3 ~ 12 grade, with an average of 6.8 grade. According to the total motion of finger joint, TAM system was used to evaluate the curative effect in 7 cases of excellent, 2 cases of good, 1 case of poor, and 90% of excellent and good. Conclusion the treatment of old Bennett fracture with appropriate release of dorsal radial ligament and Kirschner's needle fixation can obtain good curative effect.
【作者单位】：唐山市第二医院手二科唐山市第二医院解剖学教研室;
【分类号】：R687.3

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