闭合性多发掌骨骨折并发急性手部骨筋膜室综合征的处理

Treatment of closed multiple metacarpal fracture combined with acute palm osseous fascia compartment syndrome

[目的]探讨早期切开减压同时AO微型钢板内固定治疗闭合性多发掌骨骨折并发急性骨筋膜室综合征的疗效。[方法]2000年2月～2004年12月,对22例闭合性掌骨多发骨折合并骨筋膜室综合征患者,采取早期松解手部亚肌筋膜室,充分暴露每一块内在肌减压,同时对多发掌骨骨折行AO微型钢板内固定,术后辅以早期康复锻炼。[结果]所有病例术后随访3个月～2a,平均6个月,X线片显示8～12周有骨痂生成,骨折完全愈合。骨折无成角畸形及骨不连发生,无爪形手畸形,按照中华医学会手外科学会手部功能评定试用标准[1]:优13例,良8指,差1例,总优良率95.5%。[结论]采用早期切开减压同时AO微型钢板内固定治疗闭合性多发掌骨骨折并发急性骨筋膜室综合征是一种可取的、疗效满意的方法。

[ Objective ] To study the treatment of closed multiple metacarpal fracture combined with acute palm osseous fascia compartment syndrome with early incision decompression and internal fixation with AO mini-plate. [ Method ] From February 2000 to December 2004, 22 cases were treated with AO mini-plate for closed multiple metacarpal fractures and early incision decompression for combined acute palm osseous fascia compartment syndrome. Early-stage rehabilitation was carried out after operative. [ Result] Postoperative follow-up ranged from 3 to 24 months （average 6 months） in all cases. The roentgenographic evidence showed that bone union had been achieved from 8 to 12 weeks postoperatively and no claw hand occurred. According to the probation standard of amputated finger function evaluation from the Hand Surgery Plant of Chinese Medical Association, 13 fingers achieved excellent results, 8 fingers got well and 1 got unsatisfactory result. The total satisfactory rate was 95.5 %. [ Conclusion] For closed multiple metacarpal fracture combined with acute palm osseous fascia compartment syndrome, early incision decompression and internal fixation with AO mini-plate is an advisable and satisfactory treatment.