单根弹性髓内针治疗青少年掌骨骨折

Single elastic stable intramedullary nailing for metacarpal fractures in adolescents

目的介绍单根弹性髓内针治疗青少年掌骨骨折的指征、方法,并与其他方法作比较,评价其疗效。方法收集2009年3月至2011年12月采用单根弹性髓内针技术治疗的掌骨骨折26例,均为男性,平均年龄14.5岁,第5掌骨颈骨折15例,第4、5掌骨颈骨折3例,第2、第4掌骨体骨折各1例,第5掌骨体骨折3例,第4、5掌骨体骨折2例,第1掌骨底骨折1例。右手23例,左手3例。所有患儿掌骨骨折符合正位片成角>10°,斜位片成角>40°,纵向短缩超过2mm,或伴有骨折端旋转畸形。对此26例患儿在麻醉下行闭合复位,弹性髓内针固定术,术后手部功能位石膏3周。术后3个月拔除弹性钉。结果所有病例均获随访,最长2年2个月,最短3个月。从患儿X线片表现,临床检查结果(客观指标),患儿对手术的满意度(主观感觉)3方面对结果进行评价。所有患儿掌骨骨折均达到解剖复位,无一例存在成角、短缩或旋转畸形,未发生掌骨头缺血坏死,无慢连接或不连接,术后3个月均能顺利拔除髓内针,无再骨折发生。主动及被动活动度(ASSH-TAF-score)均能达到>220°,抓握力(Vernier-Dynamometer)与健侧对比,无一例发生手指或手抓握力的丢失,感觉功能良好。患儿对手术的满意度参照MHQ,均未出现轻度以上疼痛,对手外观满意,对手功能非常满意。26例患儿均未发生感染,仅1例有轻度针尾激惹。结论青少年骨骼塑形能力丧失,对有成角移位的掌骨骨折应当积极地采取手术治疗,与克氏针和钢板相比,单根弹性髓内针治疗青少年掌骨骨折具有操作简单、易于复位、避免感染、无需额外固定或理疗、功能恢复完全等优点,是一种微创、安全、有效、值得推广的手术治疗方法。

Objective To introduce the indicates and methods of single elastic stable intramedullary nailing(ESIN)in treating metacarpal(MC)fractures for adolescents and evaluate the results by comparing with other methods.Methods 26 cases(male 26)were managed with single ESIN in our hospital from March 2009 to December 2011.Age from 10 to 18 years(mean 14.5 years).Fracture in distal MC 5 were 15 cases;In distal MC 4 and 5 were 3 cases;In proximal MC 1 was 1 case and the others were located in the diaphysis.The right hand was injured 23 times and the left 3 times.All cases had MC fractures with a sagittal angulation more than 40°,an angulation more than 10° in the frontal plane,a longitudinal shortening more than 2 mm,and any rotational misalignment.The fracture was at first close reduced under general anesthesia.Then applied the ESIN and cast for 3 weeks.Results All cases were given follow-up visit(3 months-2 years 2 months).To evaluate the results from X-ray,clinical examination and patient′s satisfaction.X-ray showed complete union of the fracture without deviation of axis.All patient gained full range of motion.There was no loss of grip strength and patients were very satisfied with the surgery.Conclusions For adolescents,the remodeling capacity has ceased and the treatment needs to be more aggressive to achieve a satisfactory outcome.This method can be offered as an effective and safe alternative in the treatment of closed displaced fractures of MC in adolescents without significant complications.