应用微型外固定架和克氏针治疗尺掌侧骨折块复位不良型Bennett骨折

Treatment of Bennett fracture with inadequate reduction of the ulno-volar fragment with mini-external fixator and k-wire

目的 回顾分析应用微型外固定架和克氏针闭合复位治疗尺掌侧骨折块复位不良型Bennett骨折的方法和疗效.方法 2011年3月-2016年1月,应用微型外固定架闭合复位治疗Bennett骨折58例,其中尺掌侧骨折块复位不良型6例.常规X线透视下闭合复位脱位的第1腕掌关节,外固定架锁定维持复位.用1枚克氏针经大鱼际尺远侧缘推挤复位尺掌侧骨折块,再用另一枚克氏针经大鱼际将尺掌侧骨折块与第1掌骨固定.术后早期功能锻炼,定期检查和评估患指影像学结果,记录患指的VAS评分和双侧拇指的握力、捏力、TAM、外展角度.结果 6例尺掌侧骨折块均良好复位.骨折愈合时间6~8周,平均7.4周.术后随访8-22个月,平均11.5个月.最终随访时,影像学检查见骨折愈合良好,未见关节面分离或出现台阶,无明显骨关节炎表现.患侧拇指握力、捏力、TAM和外展角度与健侧比较无统计学差异,与尺掌侧骨折块位置正常者亦无明显统计学差异.结论 应用微型外固定架结合克氏针闭合复位治疗尺掌侧骨折块复位不良型Bennett骨折具有软组织损伤小、坚强固定的优点,术后患者可早期功能锻炼,恢复快、并发症少、疗效确切.

Objective To retrospectively analyze the method and clinical outcome of the Treatment of Bennett fracture with inadequate reduction of the ulno-volar fragment with mini-external fixator and k-wire. Methods 58 patients with Bennett fracture treated with mini-external fixator in our hospital from March 2011 to January 2016 were involved in this study, including 6 cases with inadequate reduction of the ulno-volar fragment. Closed reductions under fluoroscopy of the first metacarpophalangeal joint were to be achieved, then the external fixators were locked to maintain the reduction. A K-wire was used to push the ulno-volar fragment to the first metacapus, the other one was used to fix the fragment percutaneously. Early postoperative functional exercise and regular reexamination were required, and the VAS score, grip and pinch strength, TAM and abduction angle were evaluated and documented. Results The fractures of the 6 cases were reduced and maintained perfectly. All the fractures healed 6-8 weeks postoperatively, with an average 7.4 weeks. The follow-up period ranged from 8-22 months, with an average 11.5 months. Compared with the contralateral thumb and the group with normal position of the fragment at final follow-up, the grip strength, pinch strength, TAM and abduction angle had not significant differences. Conclusion External fixation with mini-external fixator and K-wire is a reliable and effective method for Bennett fracture with inadequate reduction of the ulno-volar fragment with advantages of less soft tissue damage, rigid fixation, fast recovery and fewer complications.