应用微型外架治疗急性第一掌骨基底骨折

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。

The Application of Miniature Outer Frame in the Treatment of Acute Base Fractures of the First Metacarpal

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.