弹性髓内钉对掌骨骨折的外科治疗

The Surgical Treatment of Elastic Intramedullary Nailing on Metacarpal Fractures

背景与目的:大多数的掌骨骨折可以采取保守治疗的方法。手术适合于一些特定的病例如:在骨折侧位片上成角大于30度、短缩超过5mm或者有旋转移位。本文的目的是分析应用预弯1.6mm克氏针治疗关节外掌骨骨折的临床效果。方法:先将克氏针弯曲成尖部弯曲大约在5mm左右,较长的轴部向着与尖部相反的方向弯曲的稳定S型。首先用2.5mm的钻头钻入掌骨基底部,然后用克氏针的尾部顺行插入,当克氏针经过骨折部位时复位骨折。应用克氏针三点固定的原理固定骨折,用手指夹板固定,早期进行掌指关节的活动。结果:自2009年到2010年我们探索性的固定了5例第五掌骨和2例第一掌骨。病人的平均年龄是35岁,其中6例男性、1例女性。外科治疗的平均时间是13天(4天至28天),骨折全部愈合良好。克氏针拔出的平均时间是4.5周(3至6周)。结论:单根预弯克氏针治疗掌骨骨折,不仅简单、快捷而且可以早期行患手各关节功能练习,使手部关节功能获得满意恢复。

Background and Objective： The majority of metacarpal fractures can be treated conservatively.Nevertheless,surgical treatment is justified in certain cases which angulation at the fracture site in a true lateral radiograph of at least 30 degrees,shortening of 5 mm and/or in the presence of a rotatory deformity.The aim of our study was to evaluate the clinical results of using a pre-bent 1.6mm Kirschner wire（K-wire） for extra-articular metacarpal fractures.Methods： The single K-wire is pre-bent in a lazy-S fashion that the sharp was bend at approximately 5 mm and the longer smooth curve was bent to the opposite direction.The fist using a 2.5 mm drill made an initial entry point at the metacarpal,then the K-wire was inserted blunt end in an antegrade manner and the fracture reducedwhen the wire was passed across the fracture site.The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic.Results： We reviewed used single K-wire as internal fixation of 5 little finger and 2 ring finger metacarpal fractures from November 2009 to August 2010.The average age of the cohort was 35 years with 1 women and 6 men.The time to surgical intervention was a mean 13 days（range 4 to 28 days）.All fractures proceeded to bony union.The pre-bent single K-wire was allow early unimpeded movement in wrist and hand together which extracted at an average of 4.5 weeks.Conclusions： With this simple and minimally invasive technique per-formed as day-case surgery,all patients were able to start mobilisation.early as soon as possible.The general outcome was good hand function with few complications.