CAJ | 학술논문

目的探讨钩骨钩骨折的临床分型,并探讨不同分型的钩骨钩骨折合理的治疗选择.方法回顾性研究了12例钩骨钩骨折的病例,依据损伤特点和预后将其分为三型:Ⅰ型为钩骨钩尖端的撕脱骨折,Ⅱ型为钩骨钩中段的骨折,Ⅲ型为钩骨钩基底的骨折.依据这一分型,本组病例中Ⅰ型1例、Ⅱ型7例、Ⅲ型4例.其中保守治疗3例,骨折切开复位内固定4例,钩骨钩切除5例;术前合并尺神经损伤3例(2例Ⅱ型,1例Ⅲ型),合并小指指屈肌腱损伤2例(均为Ⅱ型骨折),合并豆三角关节脱位1例(Ⅱ型骨折).重点分析了术后功能恢复情况、恢复时间,以及临床分型与术前并发症和疗效的相关性.结果本组随访时间为4～16个月,平均(8.4±3.9)个月.进行保守治疗和切开复位内固定7例中有2例Ⅱ型骨折发生骨折不愈合,其他5例骨折均愈合.所有患者至最终随访时均对疗效表示满意或非常满意,其疼痛评分、握力均较术前显著改善.术前并发症经手术治疗均完全缓解.采用钩骨钩摘除术的患者术后恢复时间显著短于其他两种治疗方法.Ⅱ型骨折术前并发症和骨折不愈合的发生率都较其他两型高.结论钩骨钩骨折的总体疗效是非常令人满意的.对Ⅰ型骨折和无移位的Ⅲ型骨折,可采用保守治疗.对有移位的Ⅲ型骨折,可行切开复位内固定.对Ⅱ型骨折,由于其并发症的发生率较高,应尽早行钩骨钩摘除术.
목적 탐토구골구골절적림상분형,병탐토불동분형적구골구골절합리적치료선택.방법 회고성연구료12례구골구골절적병례,의거손상특점화예후장기분위삼형:Ⅰ형위구골구첨단적시탈골절,Ⅱ형위구골구중단적골절,Ⅲ형위구골구기저적골절.의거저일분형,본조병례중Ⅰ형1례、Ⅱ형7례、Ⅲ형4례.기중보수치료3례,골절절개복위내고정4례,구골구절제5례;술전합병척신경손상3례(2례Ⅱ형,1례Ⅲ형),합병소지지굴기건손상2례(균위Ⅱ형골절),합병두삼각관절탈위1례(Ⅱ형골절).중점분석료술후공능회복정황、회복시간,이급림상분형여술전병발증화료효적상관성.결과 본조수방시간위4～16개월,평균(8.4±3.9)개월.진행보수치료화절개복위내고정7례중유2례Ⅱ형골절발생골절불유합,기타5례골절균유합.소유환자지최종수방시균대료효표시만의혹비상만의,기동통평분、악력균교술전현저개선.술전병발증경수술치료균완전완해.채용구골구적제술적환자술후회복시간현저단우기타량충치료방법.Ⅱ형골절술전병발증화골절불유합적발생솔도교기타량형고.결론 구골구골절적총체료효시비상령인만의적.대Ⅰ형골절화무이위적Ⅲ형골절,가채용보수치료.대유이위적Ⅲ형골절,가행절개복위내고정.대Ⅱ형골절,유우기병발증적발생솔교고,응진조행구골구적제술.
Objective To explore the clinical classification of hamate hook fractures and the treatment strategies for different types of fractures.Methods Twelve cases of hamate hook fractures were retrospectively reviewed.According to the fracture sites and the prognosis,the hamate hook fractures were classified into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of the hamate hook,while type Ⅱ presented as a fracture in the middle part of the hanate hook,and type Ⅲ represented a fracture at the base of the hamate hook.According to such a classification,in our series there was only 1 case of type Ⅰ,7 cases of type Ⅱ,and 4 cases of type Ⅲ.Threecases were treated conservatively,while 4 cases were treated with open reduction and internal fixation and another 5 cases with hamate hook excision.Pre-operative ulnar nerve injury co-existed in 3 cases (2 cases of type Ⅱ and 1 case of type Ⅲ).Flexor digiti minimi tendon injury co-existed in 2 cases (type Ⅱ),while pisiform-triquetral joint dislocation co-existed in 1 case (type Ⅱ).The results were evaluated with respect to the functional recovery,recovery time,the relationship between clinical classification,pre-operative complications and the treatment outcomes.Results The average follow-up time of this group was (8.4 ± 3.9) months,ranging from 4 to 16 months.Among the 7 cases treated with conservative measures or open reduction and internal fixation 2 had fracture non-union.Both cases were type Ⅱ fractures.The other 5 cases all achieved bone union.All the patients were satisfied at time of the last follow-up.Their pain scale and grip strength improved significantly after the treatment.All the pre-operative complications were relieved.The recovery time of patients treated with hamate hook excision was significantly shorter than those treated with other two methods.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.Conclusion The general therapeutic effects of hamate hook fractures are quite satisfactory.Type Ⅰ and type Ⅲ fractures without displacement can be treated with conservative measures.Type Ⅲ fractures with displacement can be treated with open reduction and internal fixation.Type Ⅱ fractures,due to the higher complication incidence,should be treated with hamate hook excision.