利用残留关节面修复外伤性掌骨头缺损

目的：探讨利用残留关节面修复重建掌骨头部分缺损的临床效果。方法2009年5月至2014年4月，我们收治外伤性掌骨头部分缺损患者24例，按照设计方案用骨刀切取掌骨头残留关节面，用缝线或克氏针将其重新固定于掌骨头顶端及掌侧，从而重建掌骨头关节面。结果24例患者均获随访，骨折一期愈合，愈合时间为1.5~4.0个月，无骨坏死及关节面吸收，掌指关节功能满意。根据临床症状进行评定：优19例，良5例。根据X线片征象评定：优22例，良2例。按照中华医学会手外科学分会全指关节主动活动度（total active motion, TAM）系统评定：优15例，良6例，可3例，优良率为87.5%。结论利用残留关节面重建掌骨头，关节活动功能恢复满意，为外伤性掌骨头部分缺损的重建提供新的术式。

Repair of traumatic defect of metacarpal head with residual articular surface

Objective To investigate the clinical effect of repair of traumatic defect of metacarpal head with residual articular surface. Methods From May 2009 to April 2014, 24 patients with traumatic meta?carpal bone defect were treated. According to the design scheme, the residual articular surface was cut by bone knife, and the top and the palm side of joint surface of the metacarpal head were reconstructed with suture or Kirschner wire. The articular surface of the metacarpal head was reconstructed. Results All patients were fol?lowed up, and the fracture healed with the healing time from 1.5 to 4 months. No bone necrosis and joint surface absorption were observed. According to the clinical symptoms, efficacy was excellent in 19 cases, and good in 5 cases. Twenty?two cases had excellent results and 2 cases had satisfactory results according to X?ray film fea?tures. By the standard of the total active motion (TAM) system evaluation of the Chinese Medical Association hand surgery branch, clinical efficacy was excellent in 15 cases, good in 6 cases, and fair in 3 cases. The per?centage of being excellent and good was 87.5%. Conclusion Reconstruction of the articular surface of the de?fected metacarpal head with residual articular surface can obtain the good joint function. The present method provides a new technique for the repair of partial defects of the traumatic palm bone.