三种固定方式治疗第五掌骨颈骨折的疗效比较

Comparison study of three fixation methods for the treatment of the fifth metacarpal neck fractures

目的分析比较闭合复位克氏针横行固定、切开复位交叉克氏针固定及切开复位接骨板螺钉固定治疗第五掌骨颈骨折的临床疗效。方法自2010年3月至2017年1月,我们共收治第五掌骨颈新鲜骨折患者83例,其中34例采用闭合复位克氏针横行固定(A组),22例采用切开复位交叉克氏针固定(B组),27例行切开复位接骨板螺钉固定(C组)。根据手术时间、C臂机透视次数、并发症、关节功能恢复、握力及患者满意度等指标,综合评价三种术式的疗效。结果术后83例均获得7~33个月的随访,平均16.5个月,骨折均获得解剖复位,达到骨性愈合。最后一次随访时,三组握力、骨折愈合时间、并发症及C臂机透视次数差异无统计学意义(P>0.05)。A组和B组、A组和C组手术时间比较,差异有统计学意义(P<0.05),B组和C组差异无统计学意义(P>0.05)。按中华医学会手外科学会上肢部分功能评定试用标准评定,A组:优27例,良4例,可3例,优良率为91.2%;B组:优15例,良5例,可2例,优良率为90.9%;C组:优16例,良7例,可4例,优良率为85.2%。结论新鲜第五掌骨颈骨折采用闭合复位克氏针横行固定治疗,操作简便,手术时间短,固定牢靠,对关节和肌腱激惹小,允许早期进行功能锻炼,治疗效果较满意,值得临床推广应用。

ObjectiveTo compare the clinical efficacy of closed reduction Kirschner wire transverse fixation,open reduction Kirschner wire cross fixation and open reduction plate screw fixation in the treatment of the fifth metacarpal neck fractures.MethodsFrom March 2010 to January 2017,83 patients with fresh closed fifth metacarpal neck fractures were treated by closed reduction Kirschner wire transverse fixation(34 cases as group A),open reduction Kirschner wire cross fixation(22 cases as group B)and open reduction plate screw fixation(27 cases as group C).According to the operation time,the number of C-arm fluoroscopy,complications,joint function recovery,grip strength and patient satisfaction,the efficacy of the three surgical methods was evaluated comprehensively.ResultsAll the 83 patients were follow-up for 7 to 33 months with an average of 16.5 months.All the fractures achieved anatomical reduction and bone healing.At the last follow-up,there were no significant differences in grip strength,fracture healing time,complications and C-arm fluoroscopy frequency among the three groups(P>0.05).The operative time between group A and group B,group A and group C were significantly different(P<0.05),and there was no significant difference between group B and group C(P>0.05).According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,the results were rated as excellent in 27 cases,good in 4 cases and fair in 3 cases with the excellent and good rate being 91.2%for group A;the results were rated as excellent in 15 cases,good in 5 cases and fair in 2 cases with the excellent and good rate being 90.9%for group B;the results were rated as excellent in 16 cases,good in 7 cases and fair in 4 cases with the excellent and good rate being 85.2%for group C.ConclusionThe application of closed reduction Kirschner wire transverse fixation in the treatment of fresh closed fifth metacarpal neck fractures has the advantages of easy operation,short operation time,stable fixation,little joint and tendon irritation and allowing early functional exercise.It has satisfactory efficacy and is worthy of clinical promotion.