微型外固定架治疗闭合性第一掌骨基底关节内骨折

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。

Treatment of closed intra-articular fracture of the base of the first metacarpal with mini-external fixator

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-articttlar 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.