钛质弹性髓内钉顺行技术治疗青少年第五掌骨颈骨折的疗效分析

Outcome analysis of treatment of pediatric fifth metacarpal neck fractures using titanium elastic nail antegrade intramedullary fixation

目的 探讨采用钛质弹性髓内钉顺行技术治疗有明显移位的青少年第五掌骨颈骨折的临床疗效.方法 2012年2月至2014年1月我院对33例明显移位的第五掌骨颈骨折患者,应用钛质弹性髓内钉顺行技术治疗.术后随访患、健侧第五掌骨头干角及第五掌指关节活动范围,并进行统计学分析.采用前臂、肩、手残障功能评分表（DASH）评估患肢术后功能恢复情况.结果 手术平均用时15.5 min（5～ 32 min）,术中C臂机透视平均7.8次（5～13次,持续0.5s/次）,所有患者均获得解剖复位.术后平均随访16.9个月（7～ 30个月）,所有患儿骨折均获得良好愈合,无一例出现尺神经手背支麻痹、指背伸肌腱损伤、掌骨头缺血性坏死、骨不连、骨折畸形愈合等严重并发症.患侧第五掌骨头干角由术前（48.8±3.0）°改善至术后（15.8±1.8）°（P＜ 0.001）,术后第五掌骨头干角与健侧（15.0±1.6）°比较差异无统计学意义（P=0.06）,患侧术后掌指关节主动活动范围（87.9±4.3）°与健侧（89.1±4.6）°相比差异无统计学意义（P=0.35）.术后DASH评分平均1.7分（0～6.0分）.结论 采用钛质弹性髓内钉顺行技术治疗有明显移位的青少年第五掌骨颈骨折,手术操作简单、创伤及术中透视辐射量小、术后并发症少且术后疗效及功能恢复好,是一种理想的治疗方法.

Objective To assess the clinical and radiographic outcomes of antegrade intramedullary fixation with titanium elastic nail in treating displaced fifth metacarpal neck fractures in children.Methods In this prospective study,33 consecutive cases of displaced metacarpal neck fractures were treated with titanium elastic nail antegrade intramedullary fixation from February 2012 to January 2014 in our department.The average follow-up period was 16.9 months.The surgical outcome was assessed by clinical and radiographic findings including head-shaft angle of the fifth metacarpus and metacarpophalangeal joint movement.Statistical analysis was conducted to compare pre-and post-operative data.Disabilities of the Arm,Shoulder and Hand （DASH） score was used to evaluate postoperative limb function.Results The average operative time was 15.5 minutes （range,5 to 32 minutes）.C-arm fluoroscopy was used 7.8 times on average （range,5 to 13 times） during the surgical procedure and every X-ray exposure lasted 0.5 second.Anatomic reduction was achieved in all the patients.Postoperative follow-up averaged 16.9 months （range,7 to 30 months）.All the fractures healed well.Average time to union was 5.7 weeks （range,5 to 10 weeks）.There was no injury to the ulnar nerve dorsal cutaneous branch.The head-shaft angle of fifth metacarpal of the injury side was improved from （48.8 ± 3.0） ° to （15.8 ± 1.8）° postoperatively（P 〈 0.001） and was not significantly different from that of the uninjured side （P=0.06）.The average range of motion in the metacarpophalangeal joint of the injured side was not significantly different from tlat of the uninjured side（P =0.35）.The average DASH questionnaire score was 1.7 （range,0 to 6.0）.Conclusion Antegrade intramedullary fixation with titanium elastic nail is a straightforward and reliable technique that is less traumatic and requires minimal intraoperative X-ray exposure.It is ideal for treating adolescent fifth metacarpal neck fractures with good functional results and very few complications.