CAJ | 학술논문

　　目的探讨急诊应用微型外架治疗急性第一掌骨基底骨折的使用方法和疗效。方法2011年7月～2012年12月，我院应用微型外架治疗急性闭合性第一掌骨基底骨折20例，男17例，女3例。 I型（Bennett 骨折）13例，II型（Rolando骨）折4例，III型骨折3例。所有病例均在C臂透视下复位骨折并应用Stryker Hoffmann 2 micro微型外架固定，如骨折移位明显或不稳定加用克氏针固定。术后早期开始功能锻炼。定期复查拍摄患指X线片并记录骨折愈合时间、指间关节活动度（TAM法）及VAS评分。结果除2例男性I型骨折患者失访外，余18例患者均获得随访，时间5～20（平均11.6）个月。18例患者骨折均愈合，愈合时间6～12（平均7.6）w。用TAM法评价患者术后指间活动度，各型骨折患者随访时患指活动度优良率均为100%。与健侧比较：I、II和III型骨折患者TAM平均较健侧减少4.0%、8.4%和3.0%，差异无统计学意义。所有关节无不稳定发生。结论微型外架治疗急性第一掌骨基底骨折方法可靠、创伤小、疗效确切、并发症少，可以在急诊推广应用。并发症主要为日常生活不慎导致的针道感染和外伤后骨折再移位。
　　목적탐토급진응용미형외가치료급성제일장골기저골절적사용방법화료효。방법2011년7월～2012년12월，아원응용미형외가치료급성폐합성제일장골기저골절20례，남17례，녀3례。 I형（Bennett 골절）13례，II형（Rolando골）절4례，III형골절3례。소유병례균재C비투시하복위골절병응용Stryker Hoffmann 2 micro미형외가고정，여골절이위명현혹불은정가용극씨침고정。술후조기개시공능단련。정기복사박섭환지X선편병기록골절유합시간、지간관절활동도（TAM법）급VAS평분。결과제2례남성I형골절환자실방외，여18례환자균획득수방，시간5～20（평균11.6）개월。18례환자골절균유합，유합시간6～12（평균7.6）w。용TAM법평개환자술후지간활동도，각형골절환자수방시환지활동도우량솔균위100%。여건측비교：I、II화III형골절환자TAM평균교건측감소4.0%、8.4%화3.0%，차이무통계학의의。소유관절무불은정발생。결론미형외가치료급성제일장골기저골절방법가고、창상소、료효학절、병발증소，가이재급진추엄응용。병발증주요위일상생활불신도치적침도감염화외상후골절재이위。
Objective To discuss the method and therapeutic effect of miniature outer frame in the treat-ment of acute base fractures of the first metacarpal. Methods 20 cases used miniature outer frame in the treatment of acute base fractures of the first metacarpal in our hospital from Jul. 2011 to Dec.2012 were analyzed. 3 of them were female and 17 were male. We have 13 patients belong to pattern I (Ben-netts fracture), 4 belong to pattern II(Rolando fracture) and 3 belong to pattern III. All the patients were reseting fracture under the C-arm fluoroscopy, and using miniature external fixator of Stryker Hoffmann 2 micro to fixed. The Kirschner wire would be used if had obviously or unstable fracture displacement. The functional exercise were began in the early postoperative. The X-ray should be reviewed on a regu-lar basis, and the fracture healing time, activity of the interphalangeal joint according to the TAM sys-tem and the VAS score were be recorded. Results All patients were followed up except 2 male belong to pattern I. The mean of the follow-up time was 11.6 months (range from 5 to 20 months). All of the 18 patients were healed, and the mean of the healing time was 7.6 weeks (range from 6 to 12 weeks). TAM system was used to evaluate the activity of the interphalangeal joint and the excellent rate was 100%. There was no significant difference in reducing TAM score when compared with the contralateral side, and the reduced TAM score in pattern I, pattern II and pattern III were 4.0%、8.4% and 3.0%. All joints without instability occured. Conclusion The method of miniature external fixator to treat acute fracture of first metacarpal was reliable, with small trauma, definite effect, and less complications, and can be applied in emergency. The main complications were the needle of urinary infection with inadver-tently caused in everyday life and the post-traumatic fracture re-displaced .