滑车钳在波及腕掌关节的第一掌骨基底骨折手术治疗中的应用

Application of pulleys forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint

目的探讨滑车钳在波及腕掌关节的第一掌骨基底骨折手术治疗中的应用及临床效果。方法自2014年6月至2018年12月,我们共收治需手术治疗的波及腕掌关节的第一掌骨基底骨折患者14例。于拇长展肌腱与拇短伸肌腱间隙作为第一手术窗,暴露骨折端及拇指腕掌关节,在拇短伸肌腱尺侧即第一掌骨基底尺侧切开骨膜,作为第二手术窗,C形滑车钳置于骨块掌尺侧,勾住并控制骨块,助手牵引、旋前第一掌骨,直视下可看到骨块解剖复位,直径1.0或1.2 mm克氏针分别于第二、第一手术窗固定骨折及拇指腕掌关节。术后石膏固定4周后拔除固定拇指腕掌关节的克氏针,改支具固定。间断做拇指各关节康复功能训练。2~3个月后根据骨折愈合情况拔除剩余克氏针。结果本组术后伤口Ⅰ期愈合,关节面解剖复位,骨折位置佳。10例患者随访6~36个月,按照顾玉东对掌功能评定方法全部为优,拇指腕掌关节各方向活动正常,VAS评分0分7例,1分1例,2分2例。结论C形滑车钳在波及腕掌关节的第一掌骨基底骨折手术治疗中,降低了手术难度,简化了手术操作,提高了手术效果,有很强的推广意义。

Objective To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint.Methods From June 2014 to December 2018,14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated.The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window.The fracture end and carpometacarpal joint of thumb were exposed.The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window.C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments.The bone fragments were hooked and controlled.The first metacarpal bone was pulled and pronated by an assistant.Under direct vision,anatomical reduction of bone fragments can be seen.Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively.After 4 weeks of plaster fixation,Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation.The rehabilitation training of each joint of thumb was done intermittently.After 2 to 3 months,the remaining Kirschner wires were removed according to the fracture healing.Results After operation,all the wounds achieved primary healing.The articular surface was anatomically reduced and the fracture position was good.10 patients were follow-up for 6 to 36 months.According to Gu Yudong evaluation method of opposition function,all the results were rated as excellent.The movement of carpometacarpal joint of thumb was normal in all directions.The VAS score was 0 in 7 cases,1 in 1 case and 2 in 2 cases.Conclusion In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint,C-shaped pulley forceps can reduce the operation difficulty,simplify the operation and improve the operation efficacy,which has a strong promotion significance.