闭合复位顺行克氏针髓内固定结合转棒技术治疗第五掌骨颈骨折

The fifth metacarpal neck fracture treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique

目的探讨闭合复位顺行克氏针髓内固定结合转棒技术治疗第5掌骨颈骨折的临床疗效。方法回顾性分析2015年8月至2017年10月新疆克拉玛依市中心医院骨科采用闭合复位顺行克氏针髓内固定结合转棒技术治疗26例第5掌骨颈骨折患者资料。男23例,女3例;年龄12~53岁,平均25.2岁。所有患者均采用末端预弯成10°~15°的克氏针作为髓内钉从第5掌骨基底部穿入髓腔,闭合手法复位,透视确认骨折复位满意后,髓内钉穿过骨折端进入掌骨头,再利用克氏针转棒技术进一步复位固定骨折。术后石膏外固定2周,去除石膏后开始功能锻炼。术后10~16周X线片提示骨折愈合后门诊局麻下拔除克氏针。记录手术时间、患侧第5掌骨头干角、掌指关节主动活动度及末次随访时手部功能采用总主动活动度(TAM)评定。结果手术时间平均21 min(12~35 min)。23例患者骨折获解剖复位,3例未达到解剖复位,但掌骨头干角明显改善且对位良好。所有患者术后获6~29个月(平均15.8个月)随访,均达到骨折牢固愈合,无感染等发生。第5掌骨头干角从术前的61.2°±11.2°改善为术后的14.7°±3.5°,差异有统计学意义(P<0.05);术后头干角与健侧(14.6°±1.7°)相比差异无统计学意义(P>0.05)。术后患侧掌指关节主动活动度(89.3°±4.2°)与健侧(90.7°±1.5°)差异无统计学意义(P>0.05)。末次随访时依据TAM评定疗效:优22例,良3例,可1例。结论闭合复位顺行克氏针髓内固定结合转棒技术治疗第5掌骨颈骨折,手术操作简单、创伤小、并发症少、费用低、能实现二次复位、临床效果良好。

Objective To assess the clinical effects of closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique in the treatment of the fifth metacarpal neck fracture.Methods In this retrospective study,26 patients with the fifth metacarpal neck fracture were treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique at Department of Orthopaedics,Central Hospital of Karamay from August 2015 to October 2017.They were 23 males and 3 females,aged from 12 to 53 years with an average age of 25.2 years.In the intramedullary nailing,a Kirschner wire pre-bent by 10°to 15°was inserted from the base of the fifth metacarpal into the medullary canal before closed reduction.After satisfactory reduction was achieved,the Kirschner wire was inserted across the fracture site into the metacarpal head for further reduction and fixation using rod rotation technique.After operation,a plaster was applied to protect the fixation for 2 weeks.Functional exercise was started after removal of the plaster.The Kirschner wire was not removed under local anaesthesia at the outpatient department until about 10 to 16 weeks postoperation when X-ray showed fracture healing.Records of their operation time,head/shaft angle of the fifth affected metacarpal,active range of motion of the metacarpophalangeal joints and Total Active Movement(TAM)of hand function at the last follow-up were collected.Results Their operation time averaged 21 minutes(from 12 to 35 minutes).Anatomical reduction was achieved in 23 cases but not in 3 ones whose metacarpal head/shaft angle and alignment were obviously improved.Follow-ups for 6 to 29 months(average,15.8 months)showed all the patients obtained solid fracture healing with no infection or delayed fracture healing.The head/shaft angle was improved significantly from preoperative 61.2°±11.2°to postoperative 14.7°±3.5°(P<0.05)which was not significantly different from that of the healthy side(14.6°±1.7°)(P>0.05).The active range of motion of the metacarpophalangeal joint was 89.3°±4.2°after fixation removal,not significantly different from that of the healthy side(90.7°±1.5°)(P>0.05).According to TAM scores at the last follow-up,22 cases were rated as excellent,3 as good and one as fair.Conclusion In the treatment of the fifth metacarpal neck fracture,closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique is effective,because it is simple and limitedly invasive,and leads to limited complications,low costs and secondary reduction.