陈旧性Bennett骨折的病理解剖特点及临床意义

目的：探讨陈旧性Bennett骨折的病理解剖特点及临床意义。方法：自2008年8月至2010年4月手术治疗陈旧性Bennett骨折13例，术中适当松解第一腕掌关节桡背侧韧带复合体，清理骨折间隙后行解剖复位螺钉或克氏针固定骨折，并对腕掌关节行克氏针固定；同时对病灶及其邻近组织进行病理解剖观察。术后石膏固定4周后，拔除经关节克氏针。术后每月复查X线片并行TAM评分。结果：术中见所有病例均存在第一腕掌关节桡背侧韧带复合体不同程度的瘢痕挛缩，同时骨折间隙内充填大量机化组织，可伴有钙化。所有患者骨折均愈合，平均愈合时间为3个月。按TAM系统评定法评定拇指功能，本组优良率84．6％。结论：相对于新鲜Bennett骨折，陈旧性Bennett骨折有其特有的解剖特点。针对桡背侧关节囊韧带复合体行适当地骨膜下松解，同时彻底清理骨折间隙，是获得关节骨折块解剖复位的关键。

Clinicopathologic Characteristics and Surgical Treatment of Obsolete Bennett Fractures

Objective：To investigate the clinicopathologic characteristics of obsolete Bennett fractures and their clinical value. Methods：From August 2008 to April 2010, 13 patients with obsolete Bennett fractures were accepted for medical treatment. All cases received X-ray examinations, and after being correctly diag- nosed, all received operations including the following steps ： radio-dorsal ligament complex of the first metacar- pal joint was properly dobonded, fracture gaps were cleared up, fracture fragments were anatomically reduced and fixed with K-wire of screw, and at last the first metacarpal joint was fixed with K-wire acrossing the joint. Postoperatively all patients were immobilized with cast plaster for 4 weeks, and then K-wires across joints were removed. The X-ray and TAM assessing were taken every month. Results： The radio - dorsal ligament complex of the first carpometacarpal joint displayed scar contracture in all cases, meanwhile, fracture gaps were filled with a great many organization tissues which could be accompanied by calcification. The fractures of all the patients had healed, with an average healing time of 3 months. According to the TAM assessment of the thumb functions, the rate of the excellent and the good was 84.6%. Conclusions： Obsolete Bennett fractures have different clinicopathologic characteristics from acute fractures. During the operation, properly debonding of radio - dorsal ligament complex properly, thoroughly clearing up the organization tissues in the fracture gaps is very issential to anatomical reduction of the fragment and the joint.