第一掌骨基底关节内骨折内固定后40例远期随访结果

目的观察40例第一掌骨基底关节内骨折切开复位内固定术后的远期疗效。方法对1978-1998年间，在我科治疗的40例闭合性第一掌骨基底关节内骨折的患者进行远期随访观察。随访项目包括：手术当时骨折复位状况、术后拇指腕掌关节主观症状、运动受限及X线片情况。结果术后40例获得5～26年随访（7例为信访），其中14例（占35．0％）有主观症状，但大多较轻微。来院随访的33例中，17例（占51．5％）有拇指运动受限，15例（占37．5％）握、捏力下降，22例（占67．0％）X线片上有第一腕掌关节炎表现。创伤性关节炎的发生与骨折复位质量有关，差异有统计学意义（P〈0．01），且关节炎发生率随时间进展有增加的趋势。主观症状、拇指运动受限的程度与骨折复位质量无关，差异无统计学意义。结论治疗第一掌骨基底关节内骨折，无论采用切开或闭合复位的方法，均应尽力达到关节面的解剖复位。

Intra-articular fractures of the base of the first metacarpal treated by open reduction and internal fixations: long-term follow-up of 40 cases

Objective To report the long-term results of 40 cases of open reduction and internal fixations for intra-articular fractures of the base of the first metacarpal. Methods 40 of 82 patients (48.8%) with intra-articular fracture of the base of the first metacarpal treated with open reduction and internal fixations in our hospital from 1978 to 1998 were involved in the study. Quality of intra-operative reduction, post-operative motion of the first carpometacarpal joint, symptoms and signs of arthritic changes of the joint were evaluated and documented. 7 cases were evaluated by questionnaires. Results The follow-up period ranged from 5 to 26 years, with an average of 10.2 years. 14 patients (35.0%) were symptomatic. The symptoms, however, were mild. Among the 33 cases that came back for evaluation, 17 patients (51.5%) had limited thumb movement and 15 patients (37.5%) had decreased grip or pinch strength. Arthritic changes, which were found to be highly correlated with the quality of fracture reduction, were observed in 22 patients (67.0%). Only 2 patients had bilateral arthritic changes. Osteoarthritis had a tendency to develop with time. Neither late symptoms nor limitation of thumb movement was found to be correlated with the quality of fracture reduction . Conclusion Anatomical reduction, either by open or closed maneuvers, should be the goal for treatment of intra-articular fractures of the base of the first metacarpal. [WTHZ]