CAJ | 학술논문

目的：回顾分析应用微型外固定架治疗第一掌骨基底关节内骨折的使用方法和疗效。方法2011年3月-2013年3月，对21例第一掌骨基底关节内闭合性骨折患者采用微型外固定架治疗。Ⅰ型（Bennett骨折）15例，Ⅱ型（Rolando骨折）6例。 C型臂透视下复位骨折并用微型外固定架固定，如骨折移位明显或复位后不稳定则加用克氏针固定。术后早期功能锻炼，定期检查和评估患指影像学结果，记录患指的VAS评分和双侧拇指的握力、捏力、TAM、外展角度。结果术后随访3～24个月，平均10.7个月。所有患者骨折均愈合，愈合时间6～12周，平均7.7周。最终随访时，患侧拇指握力、捏力、TAM和外展角较健侧分别减少1.4%，0.8%，1.2%和5.5%，差异均无统计学意义。4例患者出现第一腕掌关节炎，关节炎的发生与关节面复位程度无明显相关性。结论微型外固定架治疗第一掌骨基底关节内骨折方法可靠、疗效确切、软组织损伤小、固定可靠、恢复快、并发症少，可以推广应用。
목적：회고분석응용미형외고정가치료제일장골기저관절내골절적사용방법화료효。방법2011년3월-2013년3월，대21례제일장골기저관절내폐합성골절환자채용미형외고정가치료。Ⅰ형（Bennett골절）15례，Ⅱ형（Rolando골절）6례。 C형비투시하복위골절병용미형외고정가고정，여골절이위명현혹복위후불은정칙가용극씨침고정。술후조기공능단련，정기검사화평고환지영상학결과，기록환지적VAS평분화쌍측무지적악력、날력、TAM、외전각도。결과술후수방3～24개월，평균10.7개월。소유환자골절균유합，유합시간6～12주，평균7.7주。최종수방시，환측무지악력、날력、TAM화외전각교건측분별감소1.4%，0.8%，1.2%화5.5%，차이균무통계학의의。4례환자출현제일완장관절염，관절염적발생여관절면복위정도무명현상관성。결론미형외고정가치료제일장골기저관절내골절방법가고、료효학절、연조직손상소、고정가고、회복쾌、병발증소，가이추엄응용。
Objective To retrospectively analyze the method and clinical outcome of the external fixation with mini-external fixator to treat intra-articular fracture of the base of the first metacarpal. Methods 21 patients with closed intra-articular fracture of the base of the first metacarpal were treated with mini-external fixator in our hospital from March 2011 to March 2013, 17 males and 4 females. Type I (Bennett fracture) was involved in 15 cases, type II (Rolando fracture) in 6 cases. Fractures were reduced under C-arm fluoroscopy and then fixed with mini-external fixator. If the fractures after reduction were unstable or displaced obviously, the internal fixation with K-wires was combined. Early postoperative functional exercise and regular reexamination were required, and the VAS score, grip and pinch strength, TAM and abduction angle were evaluated and documented. Results The follow-up period ranged from 3 to 24 months, with an average 10.7 months. All the fractures healed postoperatively 6 to 12 weeks, with an average 7.7 weeks. Compared with the contralateral at final follow-up, the grip strength, pinch strength, TAM and abduction angle decreased by 1.4%,0.8%,1.2% and 5.5% respectively. Conclusion External fixation with mini-external fixator is a reliable and effective method for intra-articular fracture of the base of the first metacarpal, with advantages of less soft tissue damage, rigid fixation, fast recovery and fewer complications. It is worth spreading and application.