中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2015年
3期
163-165
,共3页
沈恺颖%徐蕴岚%王志刚%蔡海清
瀋愷穎%徐蘊嵐%王誌剛%蔡海清
침개영%서온람%왕지강%채해청
掌骨%骨折固定术,内%拳击手骨折%钛质弹性髓内钉
掌骨%骨摺固定術,內%拳擊手骨摺%鈦質彈性髓內釘
장골%골절고정술,내%권격수골절%태질탄성수내정
Metacarpal bones%Fracture fixation,internal%Boxer's fracture%Titanium elastic nail
目的 探讨采用钛质弹性髓内钉顺行技术治疗有明显移位的青少年第五掌骨颈骨折的临床疗效.方法 2012年2月至2014年1月我院对33例明显移位的第五掌骨颈骨折患者,应用钛质弹性髓内钉顺行技术治疗.术后随访患、健侧第五掌骨头干角及第五掌指关节活动范围,并进行统计学分析.采用前臂、肩、手残障功能评分表(DASH)评估患肢术后功能恢复情况.结果 手术平均用时15.5 min(5～ 32 min),术中C臂机透视平均7.8次(5～13次,持续0.5s/次),所有患者均获得解剖复位.术后平均随访16.9个月(7～ 30个月),所有患儿骨折均获得良好愈合,无一例出现尺神经手背支麻痹、指背伸肌腱损伤、掌骨头缺血性坏死、骨不连、骨折畸形愈合等严重并发症.患侧第五掌骨头干角由术前(48.8±3.0)°改善至术后(15.8±1.8)°(P＜ 0.001),术后第五掌骨头干角与健侧(15.0±1.6)°比较差异无统计学意义(P=0.06),患侧术后掌指关节主动活动范围(87.9±4.3)°与健侧(89.1±4.6)°相比差异无统计学意义(P=0.35).术后DASH评分平均1.7分(0～6.0分).结论 采用钛质弹性髓内钉顺行技术治疗有明显移位的青少年第五掌骨颈骨折,手术操作简单、创伤及术中透视辐射量小、术后并发症少且术后疗效及功能恢复好,是一种理想的治疗方法.
目的 探討採用鈦質彈性髓內釘順行技術治療有明顯移位的青少年第五掌骨頸骨摺的臨床療效.方法 2012年2月至2014年1月我院對33例明顯移位的第五掌骨頸骨摺患者,應用鈦質彈性髓內釘順行技術治療.術後隨訪患、健側第五掌骨頭榦角及第五掌指關節活動範圍,併進行統計學分析.採用前臂、肩、手殘障功能評分錶(DASH)評估患肢術後功能恢複情況.結果 手術平均用時15.5 min(5～ 32 min),術中C臂機透視平均7.8次(5～13次,持續0.5s/次),所有患者均穫得解剖複位.術後平均隨訪16.9箇月(7～ 30箇月),所有患兒骨摺均穫得良好愈閤,無一例齣現呎神經手揹支痳痺、指揹伸肌腱損傷、掌骨頭缺血性壞死、骨不連、骨摺畸形愈閤等嚴重併髮癥.患側第五掌骨頭榦角由術前(48.8±3.0)°改善至術後(15.8±1.8)°(P＜ 0.001),術後第五掌骨頭榦角與健側(15.0±1.6)°比較差異無統計學意義(P=0.06),患側術後掌指關節主動活動範圍(87.9±4.3)°與健側(89.1±4.6)°相比差異無統計學意義(P=0.35).術後DASH評分平均1.7分(0～6.0分).結論 採用鈦質彈性髓內釘順行技術治療有明顯移位的青少年第五掌骨頸骨摺,手術操作簡單、創傷及術中透視輻射量小、術後併髮癥少且術後療效及功能恢複好,是一種理想的治療方法.
목적 탐토채용태질탄성수내정순행기술치료유명현이위적청소년제오장골경골절적림상료효.방법 2012년2월지2014년1월아원대33례명현이위적제오장골경골절환자,응용태질탄성수내정순행기술치료.술후수방환、건측제오장골두간각급제오장지관절활동범위,병진행통계학분석.채용전비、견、수잔장공능평분표(DASH)평고환지술후공능회복정황.결과 수술평균용시15.5 min(5～ 32 min),술중C비궤투시평균7.8차(5～13차,지속0.5s/차),소유환자균획득해부복위.술후평균수방16.9개월(7～ 30개월),소유환인골절균획득량호유합,무일례출현척신경수배지마비、지배신기건손상、장골두결혈성배사、골불련、골절기형유합등엄중병발증.환측제오장골두간각유술전(48.8±3.0)°개선지술후(15.8±1.8)°(P＜ 0.001),술후제오장골두간각여건측(15.0±1.6)°비교차이무통계학의의(P=0.06),환측술후장지관절주동활동범위(87.9±4.3)°여건측(89.1±4.6)°상비차이무통계학의의(P=0.35).술후DASH평분평균1.7분(0～6.0분).결론 채용태질탄성수내정순행기술치료유명현이위적청소년제오장골경골절,수술조작간단、창상급술중투시복사량소、술후병발증소차술후료효급공능회복호,시일충이상적치료방법.
Objective To assess the clinical and radiographic outcomes of antegrade intramedullary fixation with titanium elastic nail in treating displaced fifth metacarpal neck fractures in children.Methods In this prospective study,33 consecutive cases of displaced metacarpal neck fractures were treated with titanium elastic nail antegrade intramedullary fixation from February 2012 to January 2014 in our department.The average follow-up period was 16.9 months.The surgical outcome was assessed by clinical and radiographic findings including head-shaft angle of the fifth metacarpus and metacarpophalangeal joint movement.Statistical analysis was conducted to compare pre-and post-operative data.Disabilities of the Arm,Shoulder and Hand (DASH) score was used to evaluate postoperative limb function.Results The average operative time was 15.5 minutes (range,5 to 32 minutes).C-arm fluoroscopy was used 7.8 times on average (range,5 to 13 times) during the surgical procedure and every X-ray exposure lasted 0.5 second.Anatomic reduction was achieved in all the patients.Postoperative follow-up averaged 16.9 months (range,7 to 30 months).All the fractures healed well.Average time to union was 5.7 weeks (range,5 to 10 weeks).There was no injury to the ulnar nerve dorsal cutaneous branch.The head-shaft angle of fifth metacarpal of the injury side was improved from (48.8 ± 3.0) ° to (15.8 ± 1.8)° postoperatively(P ＜ 0.001) and was not significantly different from that of the uninjured side (P=0.06).The average range of motion in the metacarpophalangeal joint of the injured side was not significantly different from tlat of the uninjured side(P =0.35).The average DASH questionnaire score was 1.7 (range,0 to 6.0).Conclusion Antegrade intramedullary fixation with titanium elastic nail is a straightforward and reliable technique that is less traumatic and requires minimal intraoperative X-ray exposure.It is ideal for treating adolescent fifth metacarpal neck fractures with good functional results and very few complications.
