掌骨头关节内骨折的治疗

Treatment of intra-articular fracture of metacarpal head

目的 评价用A0微型钢板螺钉内固定治疗掌骨头关节内骨折的疗效。方法 2 4例 3 2个掌骨头骨折 ,均用切开复位加A0微型钢板螺钉内固定。术中选用T型钢板 16块 (其中 9例另加螺钉固定 ) ;使用L型钢板 12块 (其中 10例另加螺钉固定 ) ;用螺钉固定 4块。术后随访 6～ 2 4个月。结果 T型钢板、T型钢板加螺钉、L型钢板、L型钢板加螺钉、螺钉固定 5组术后均未发生感染。 5组术后平均开始活动时间分别为 8.0d、11.7d、14 .0d、11.2d和 17.5d。握力恢复百分比 (同侧 /对侧 )分别为 77 6%、80 1%、85 7%、76.0 %和 70 .7%。掌指关节平均活动范围为 81.1°、68.0°、64 .5°、70 .4°和 63 .5°。内固定平均拆除时间为 13 .4、6.17、10 .5、9 4和 9 0个月。无骨不连发生。结论 切开复位加AO内固定是一种治疗掌骨头骨折的有效方法。选择合适的手术适应证 ,熟练的手术技巧 ,适时的早期功能锻炼和理疗 。

Objective To evaluate the treatment outcome of internal fixation by AO mini-plate and screw for intra-articular fracture of the metacarpal head.Methods There were 32 metacarpal head fractures in 24 cases. Open reduction and AO mini-plate and screw internal fixation were carried out. 16 fractures were fixed by type T plate (9 with additional screw),12 by type L plate(10 with a dditional screw), and 4 by screws only. The follow-up period ranged from 6 to 24 months. Results No infection occurred in the type T plate, type T plate with screw, Type L plate, Type L plate with screw and screws only. Postoperative movement started at average 8, 11.7, 14, 11.2, and 17.5 days after surgery, respectively. The average percentage of grip strenath (ipsilateral/opposite) was 77.6%, 80.1%, 85.7%, 76.0% and 70.7%, respectively. The average range of motion of the metacarpal-phalangeal joint was 81.1°,68.0°,64.5°,70.4°and 63.5°respectively. Removal of the hardware averaged 13.4, 6.17, 10.5, 9.4, and 9 months, respectively. Conclusion Open reduction and internal fixation with AD plates is an effective way for treatment of fracture of the metacarpal head. Suitable indication, skillful operation, timely early exercises and physical therapy are the key ways of obtaining satisfactory results.