利用经皮克氏针联合微型外固定支架技术治疗第五掌骨基底部骨折的临床疗效

Percutaneous Kirschner wire fixation combined with mini external fixation for treatment of the fifth metacarpal base fractures

目的介绍经皮克氏针联合微型外固定支架技术治疗第五掌骨基底部骨折这一微创技术，并且评价其在临床使用中的治疗效果。方法本研究对11例第五掌骨基底部骨折的者进行术后随访。所有患者均在受伤后2周内接受骨折闭合复位＋经皮克氏针联合微型外固定支架固定术。术中通过外固定支架的牵引和手法复位将骨折满意复位后以2枚克氏针经皮将第五掌骨与第四、第三掌骨固定。6周后拆除外固定支架及克氏针。术后平均随访时间为15．7周，随访内容包括X线片、患肢VAS评分、手部运动功能以及手指握力，运动功能评价标准为中华医学会手外科学分会上肢部分功能评定标准TAM评分系统。结果11例患者术后X线片均显示骨折愈合，均未出现钉道感染或钉棒松动、断裂等并发症。术后平均VAS评分为1．13分。患手握力平均达到健侧的89．3％。患手运动功能根据TAM评分系统的评定标准：优6例，良4例，可1例。结论经皮克氏针联合微型外固定支架固定是治疗第五掌骨基底部骨折安全、有效的微创技术，手术操作简便，临床疗效满意。

Objective To evaluate the clinical outcomes of the minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation in the treatment of the fifth metacarpal base fractures. Methods Eleven patients underwent this minimally invasive technique were enrolled and followed up. All of the patients were diagnosed as the fifth metacarpal base fractures according to the typical X-ray manifestation. In this modified procedure, the fracture was reduced by mini external fixation traction and manual manipulation, and the fifth metacarpal was then fixed to the fourth and third metacarpal by 2 percutaneous Kirschner wires. All the fixation devices were removed 6 weeks postoperatively. The mean follow-up period was 15.7 weeks. X-ray, VAS score, range of motion （ROM） as well as the grip strength of the affected hand were checked for all the patients and the TAM scoring system was used for the function evaluation. Results All the l 1 patients achieved satisfied union for the fifth metacarpal base fractures without wire tract infection or screw rod loosening and break. The average postoperative VAS score was 1.13. The patients achieved an averaged 89.3% grip strength compared to the healthy side. According to the TAM scoring system, the results were excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation appears to be an effective and safe procedure for treatment of the fifth metacaroal base fractures.