掌骨骨折的治疗选择及疗效分析

Option and therapeutic analysis in the treatment of Metacarpal fracture

目的探讨掌骨骨折的合理内固定方法。方法本文总结掌骨骨折患者57例共有78处掌骨骨折,随机应用三种常用方法治疗骨折的效果,其中克氏针固定38处,微型钢板固定28处,螺钉固定14处。结果随访6个月到2年。克氏针组优良率达71.1%,骨折愈合时间为6～13周,平均8.3周,2处骨折不愈合,1处延迟骨愈合,1处骨折畸形愈合;微型钢板固定组优良率达92.3%,骨折愈合时间为8～14周,平均9.4周,1处骨折畸形愈合,有2处发生感染;螺钉固定组优良率92.9%,骨性愈合时间为8～10周,该组所有病例均未发生术后骨折移位或畸形愈合。结论微型钢板和螺钉内固定对掌骨骨折的手术治疗效果优于克氏针,但三种方法各有优缺点,应根据骨折类型及受伤程度选择适当的固定方法。

Objective To investigate the rational internal fixation in the treatment of the metacarpal fractures. Methods 57 cases with 78 injuries of metacarpal fractures were treated in 3 ways. Among them, 38 cases were treated with Kirschner pin fixation, 26 with micro plate fixation, 14 with screw fixation. Results All cases were followed up for 6 to 24 months. In Kirschner pin fixation group, the excellent and good rate of joint function were 71.7%, The union time was 6 to 13 weeks （average 8.3 weeks）. Nonuniom, delayed union and malunion were in 2, l and 1-site respectively. In the micro steel plate fixation group, the excellent and good rates were 92.3% and union time was 8 to 14 weeks （average 9.4 weeks）. The malunion was in 1 site and wound infection was in 2 sites. In the sciew fixation group,the excellent and good rate were 92.9%. Bony union time was 8 to 10 weeks. No postoperative fracture displacement or malumion was found. Conclusion Micro steel plate fixation and screw fixation are superior to Kirschner pin fixation. But these three internal fixation methods have their advantages and disadvantages individually. According to fracture type and injuried degree, the ffixed method should be selected reasonably.