闭合复位髓内针内固定术治疗第五掌骨颈骨折临床观察及诊断

Clinical Observation and Diagnosis of Closed Reduction and Internal Fixation with Intramedullary Nail in Treatment of Fifth Metacarpal Neck Fractures

目的:探讨闭合复位髓内针内固定术在第五掌骨颈骨折中的临床应用价值。方法:将本院收治的61例第五掌骨颈骨折患者随机分为观察组和对照组,对照组患者给予开放复位内固定术,观察组给予闭合髓内针内固定术,两组患者术后均根据中医辨证分型给予相应中药治疗,观察两组临床疗效和预后。结果:观察组骨折复位率为93.5%,术后第五掌骨头干角为(17.9±3.2)°,骨折愈合后为(15.7±2.5)°,切口愈合甲级27例,对照组骨折复位率为76.7%,术后第五掌骨头干角为(33.1±2.8)°,骨折愈合后为(24.2±3.4)°,切口愈合甲级20例,两组临床疗效差异有统计学意义(P<0.05);观察组术后掌指关节主动活动度(MCP)为(91.6±1.4)°,骨折Ⅰ级愈合患者23例,对照组术后掌指关节主动活动度(MCP)为(75.2±1.6)°,骨折Ⅰ级愈合患者15例,两组预后差异有统计学意义(P<0.05)。结论:闭合复位髓内针内固定术能显著提高第五掌骨颈骨折的临床疗效和预后,具有重要的临床应用价值。

Objective ： To explore the clinical value of closed reduction and internal fixation with intramedullary nail. Methods ： 61 cases of patients with fractures of the fifth metacarpal neck were randomly divided into the observation group and the control group in our hospital. The control group was given open reduction and internal fixation, and the observation group were treated with closed reduction and internal fixation with intramedulary nail. Both two groups＇ patients were given traditional Chinese medicine treatment according to syndrome differentiation type to observe the clinical efficacy and prognosis. Results ： The rate of fracture re-duction of the observation group was 93.5%, the postoperative head/shaft angle of the fifth metacarpal in the observation group was（ 17.9 ± 3.2 ）°, after fracture healing was（ 15.7 ± 2.5 ） ° ,27 cases of surgical incisions healed well;the rate of fracture reduc-tion of the control group was 76.7%, the postoperative head/shaft angle of the fifth metacarpal in the control group was（33.1 ± 2. 8 ）°, after fracture healing was （24.2 ± 3.4）°, 20 cases of surgical incisions healed well;the difference between two groups was highly significant（ P 〈 0.05 ） ;postoperative knuckles active activity of the observation group was （91.6 ± 1.4） ° ,23 patients with fractures healed well, postoperative knuckles active activity of the control group was （91.6 ± 1.4）°, 15 patients with fractures healed well, the difference between two groups was highly significant（P 〈 0. 05 ）. Conclusion：The technique can significantly im-prove the clinical efficacy and prognosis in the treatment of the fifth metacarpal neck fractures. It has important clinical value.