钩骨-掌骨关节损伤的分型及治疗

Classification and treatment in the injury of hamatometacarpal joint

目的探讨钩骨-掌骨关节损伤的分型、治疗方法及疗效。方法对17例钩骨-掌骨关节损伤患者进行回顾性分析,男16例,女1例;年龄19～51岁。根据钩骨的损伤情况先分为四型,再根据掌骨基底脱位伴/不伴骨折分为两个亚型。腕掌关节韧带损伤,钩骨无骨折,第4和(或)第5掌骨基底脱位或半脱位为Ⅰa型,伴骨折为Ⅰb型;钩骨背侧撕脱性骨折,第4和(或)第5掌骨基底脱位或半脱位为Ⅱa型,伴骨折为Ⅱb型;钩骨背侧粉碎性骨折,第4和(或)第5掌骨基底脱位或半脱位为Ⅲa型,伴骨折为Ⅲb型;钩骨冠状面劈裂骨折,第4和(或)第5掌骨基底脱位或半脱位为Ⅳa型,伴骨折为Ⅳb型。17例钩骨-掌骨关节损伤患者Ⅰb型7例,Ⅱa型2例,Ⅱb型1例,Ⅲb型2例,Ⅳa型1例,Ⅳb型4例。针对不同类型损伤选择闭合或手术治疗。结果患者伤口均一期愈合,骨折愈合率为100%。术后随访4～96个月。无一例患者发生创伤性关节炎、感染、神经损伤和肌腱粘连等并发症。结论稳定的钩骨-掌骨关节损伤可采用闭合复位、石膏或支具固定治疗,但应密切随访;关节内和不稳定骨折一般选择手术治疗。短期随访创伤性关节炎的发生率较低。

Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.