闭合复位克氏针横向固定治疗第5掌骨基底骨折

Closed reduction and transverse fixation with Kirschner wires for the fifth metacarpal base fracture

目的比较闭合复位克氏针横向固定与切开复位微型接骨板或克氏针固定治疗第5掌骨基底骨折的疗效。方法回顾性分析2005年8月至2012年5月治疗50例伴有短缩或腕掌关节脱位的新鲜第5掌骨基底骨折患者资料，其中26例采用闭合复位固定（男22例，女4例；年龄17-41岁，平均28岁；OTA分型：A1型8例，B1型11例，C1型7例；3例伴腕掌关节脱位），24例采用切开复位固定（男21例，女3例；年龄19-46岁，平均26岁；OTA分型：A1型11例，B1型8例，C1型5例；伴腕掌关节脱位2例；微型接骨板固定7例，交叉克氏针固定17例）。采用中华医学会手指总主动活动度（TAM）评价关节活动范围。结果闭合复位组手术时间14-33min，平均（23±13）min；治疗费用2018-2995元，平均（2673±334）元。切开复位组手术时间45-105min，平均（57±20）min；治疗费用3874-4793元，平均（4138±416）元。闭合复位组23例获得6-26个月（平均16．5个月）随访，骨折均解剖复位，骨折愈合时间4-7周，平均4．9周；TAM评价，优15例，良6例，可2例，优良率91.3％（21／23）。切开复位组22例获得6-21个月（平均15-3个月）随访，骨折均解剖复位，骨折愈合时间4～8周，平均5．8周；TAM评价，优13例，良7例，可2例，优良率90．9％（20／22）。结论闭合复位克氏针横向固定治疗第5掌骨基底骨折，操作简便，固定可靠，疗效满意；手术时间短，治疗费用低。

Objective To compare the therapeutic effects of closed reduction and transverse fixation with Kirschner wires and open reduction and fixation with mini-plates or Kirschner wires for the fifth metacarpal base fracture. Methods Data of 50 patients, who had been treated in our hospital for the fifth metacarpal base fracture from August 2005 to May 2012, were enrolled in this study. Twenty-six patients un- derwent closed closed reduction and transverse fixation with Kirsehner wires, including 22 males and 4 fe- males, aged from 17 to 41 years; according to the OTA classification, there were 8 of type A1, 11 of type B1, and 7 of type C1. Twenty-four patients underwent open reduction and fixation with mini-plates or Kirschner wires, including 21 males and 3 females, aged from 19 to 46 years （average, 26 years）; according to the OTA classification, there were 11 of type A1, 8 of type B1 and 5 of type C1. The total active motion （TAM） score of Chinese Medical Associaition was used to evaluate the range of motion of the joint. Results In closed reduction group, the operation time ranged from 14 to 33 min; the treatment costs ranged from 2018 to 2995 yuan; 23 patients were followed up for 6 to 26 months; X-rays showed the anatomic reduction was achieved in all patients, and the fracture healing time ranged from 4 to 7 weeks; according to the TAM score, the re- sult was excellent in 15, good in 6 and fair in 2, and the excellent and good rate was 91.3%. In open reduction group, the operation time ranged from 45 to 105 min; the treatment costs ranged from 3874 to 4793 yuan; 22 patients were followed up for 6 to 21 months; X-rays showed the anatomic reduction was achieved in all patients, and the fracture healing time ranged from 4 to 8 weeks; according to the TAM score, the result was excellent in 13, good in 7 and fair in 2, and the excellent and good rate was 90.9%. Conclusion Closed reduction and transverse fixation with Kirsehner wires is an effective method for the fifth metacarpal base fracture, which has several advantages, such as simple operation, stable fixation, satisfactory results, short operation time and low treatment costs.