陈旧性Bennett骨折的解剖病理特点及手术治疗

Clinicopathologic characteristics and surgical treatment of obsolete Bennett fractures

目的探讨陈旧性Bennetl骨折的解剖病理特点、F术治疗及预后。方法2008年8月至2010年4月共收治13例陈旧性Bennett骨折患者，男12例，女1例；年龄17-42岁，平均34．3岁。受伤至于术时间为4-12周（平均7．9周），所有患者经x线检杏确诊后手术治疗，适1松解第l腕掌关市桡背侧韧带复合体，清理骨折问隙，解削复位并固定关节骨折块，对腕掌关节行克氏针固定。术后石膏固定4周后，拔除经关肖克氏针，并行渐进性功能锻炼。每月复查X线片。结果所有患者术后获6-24个月（平均14个月）随访。全部患者骨折均获愈合，平均愈合时问为3个月，未发生关节再脱位等并发症。1例合并大多角骨父再软骨损伤，其他12例均无明显疼痛。按总主活动度系统评定法评定拇指功能：优9例，良2例，中1例，差1例，优良率为84．6％。结论第1腕掌火仃桡背侧韧带复合体发生瘢痕挛缩是陈旧性Bennett骨折的病理特点，将影响桡背侧关节的骨折块复他。术中适当骨膜下松解桡背侧关节囊韧带复合体址获得桡背侧关节骨折块解剖复位的关键。受伤时间越过3个月、合并大多角骨关节软骨损伤叮能足影响陈旧性Bennett骨折预后的重要因素。

Objective To investigate clinicopathologic characteristics of obsolete Bennett fractures and their surgical treatment and prognosis. Methods From August 2008 to April 2010, 13 patieuts with obsolete Bennett fracture were admitted In our departnlent. They were 12 men and one woman, with an aw^rage age of 34. 3 years （from 17 to 42 years）. They had a fi＇acture histm3, of over 4 weeks to as long as 12 weeks （average, 7.9 weeks）. In all patients, after X-ray examinations, the radio-dorsal ligament complex of the first eaq^ometacarpal joint was properly released, fractnre gaps were cleared up, fracture t＇ragments were anatomi- cally reduced and fixed v,＇ith a Kirschner wire, and at last the t^rst metacarpal joint was fixed with the Kirschner wire crossing the joint. Postoperatively all patients were immobilized wilh cast plaster for 4 weeks before the Kirschner wires across the joint were removed. Gradt,al rehabilitation was conducted. The X-rays were taken every month. Results The patients were followed h^r 6 to 24 months（average, 14 months） . The fractures healed in all the patients, with an average healing time of 3 months. No disloeation of the joints occurred. Injury to articular cartilage of the trapezium bone occurred in one patient, and no apparent pain was experi- enced in the other 12 patients. According to the Total Active Motion assessment, the thumb function was rated as exeellent in 9 cases, good in 2, moderate, in one and poor in one, with a good to excelleut rate of 84.6%. Conclusions In obsolete Bennett fractures, the radio-dorsal ligament complex of the first ear- pometacarpal joint will have eicatricial eoulraclure, preventing reduction of the fragments of the radin-dnl.＇sal joint. Therefore it is important to properly release the radio-dorsal ligament complex to achieve anatomical reduetion of the radio-dorsal joint. An injury hislory of over 3 months and complicated injury to the trapezium bone cartilage may be significant facto~ affecting the prognosis of obsolete Bennett factures.