第1掌骨基底部骨折手术治疗疗效分析

Analysis of Operative Effect on Base Fracture of First Metacarpal

目的比较不同的手术方法、手术距受伤时间、术后外固定时间的长短对第1掌骨基底部骨折最终疗效的影响。方法2000年1月—2007年10月,手术治疗62例第1掌骨基底部骨折,其中克氏针固定32例,微型螺钉固定20例,微型钢板固定10例:手术距受伤时间间隔<2周者41例,>2周者21例;手术后石膏等辅助外固定时间<6周者41例,>6周者21例。术后随访至内固定物取出后功能康复锻炼无明显进展为止。功能评定采用TAM系统评定法,评定结果分别进行统计学分析。结果克氏针固定、微型螺钉固定、微型钢板固定术后功能康复优良率分别为63.1%、75.0%、70.0%,三组差异无统计学意义(P>0.05);手术距受伤时间<2周及>2周术后功能康复优良率分别为78.0%、52.4%,2周内手术组优于2周后手术组(P<0.05);手术后石膏等辅助外固定时间<6周及>6周者术后功能康复优良率分别为81.4%、42.1%,术后第1腕掌关节固定>6周组明显优于术后外固定>6周组(P<0.01)。结论第1掌骨基底部骨折手术治疗,手术距受伤的时间及术后外固定的时间是影响术后第1掌腕关节功能恢复的主要因素。

Objective To compare the functional outcomes of different operative approaches. Methods From January 2000 to October 2007, 62 cases of base fracture of first metacarpal were treated with fixation by Kirschner wire, micro-plate and micro-screw, respectively. Of a11 the cases, 32 were fixed by Kirschner wire, 20 by micro-screw and 10 by micro-plate. There were 41 cases whose interval between the beginning of wound and operation was shorter than or equal to two weeks and 21 cases whose interval was over two weeks. The external fixation duration was shorter than or equal to six weeks in 41 cases, and it was over six weeks in 21 cases. Functional outcomes were measured by TAM system and the data were analyzed statistically. Results The good or excellent rates of functional rehabilitation were 63.1% （by Kirschner wire）, 75% （by micro-plate）, and 70% （micro-screw）, respectively, among which there were no statistical differances （P〉0.05）. For those whose interval between the beginning of wound and operation was shorter than or equal to two weeks, the good or excellent rate was 78%, and for those whose interval was over two weeks, the counterpart was 52.4%, significantly lower than the former （P〈0.05）. As for the external fixation duration, the good or excellent rates were 81.4% for those whose duration was shorter than or equal to six weeks, and 42.1% for those whose duration was over six weeks （P〈0.01）. Conclusion The interval between the beginning of wound and operation, as well as the duration of external fixation, is the major factor that influences the functionally terminal rehabilitation.