改良闭合经皮固定和切开复位治疗Bennett骨折疗效分析

Clinical analysis of modified closed percutaneous fixation and open reduction in the treatment of Bennett fracture

目的分析比较改良闭合复位经皮内固定和切开复位内固定治疗Bennett骨折的疗效。方法自2016年4月至2018年6月符合纳入标准患者38例,其中改良闭合复位经皮克氏针固定组(A组)21例,切开复位内固定组(B组)17例。所有患者术后定期随访,复查X线片,骨折愈合后拔除克氏针。分别记录术中手术时间,采用视觉模拟评分法(visual analogue scale,VAS)评估拇指关节疼痛情况,并测量第一腕掌关节屈伸活动度(range of motion,ROM)及内收外展ROM,测力计测量握力;按总主动活动度(total active motion,TAM)系统评定法评定患指功能;根据末次随访时X线片,采用Eaton-Littler分期评估创伤性关节炎发生情况。结果所有患者术后随访12~24个月,平均15.4个月。骨折均骨性愈合,A组愈合时间为5.0~7.8周,平均6.2周;B组愈合时间为5.2~8.4周,平均6.5周。A组手术时间15~35 min,平均(21.3±0.3)min;B组30~45 min,平均(38.5±0.2)min。末次随访时VAS评分A组为(0.85±0.05)分,B组为(0.72±0.04)分。第一腕掌关节屈伸ROM、收展ROM及握力两组比较,差异均无统计学意义(P>0.05)。按TAM系统评定法评定患指功能:A组优良率为90.4%,B组为88.2%。Eaton-Littler分期评估创伤性关节炎:A组,Ⅰ期3例,Ⅱ期1例;B组,Ⅰ期1例。结论两种手术方式都能得到较为满意的结果,改良闭合复位经皮内固定手术时间耗时更短,但术后出现创伤性关节炎的可能性更大。

Objective To analyze and compare clinical efficacy of modified closed reduction percutaneous internal fixation and open reduction internal fixation in the treatment of Bennett fracture.Methods From April 2016 to June 2018,a total of 38 patients met the inclusion criteria were incorporated in the study,including 21 cases in modified closed reduction percutaneous Kirschner wire fixation group(group A)and 17 cases in open reduction internal fixation group(group B).All the patients were followed up regularly after operation and reviewed by X-ray films,and Kirschner wire was removed after fracture healing.The intraoperative operation time was recorded,the thumb joint pain was evaluated by visual analogue scale(VAS),the range of motion(ROM)and adduction/abduction ROM of the first carpometacarpal joint were measured,and the grip strength was measured by dynamometer.The finger function was evaluated according to the total active motion(TAM)system evaluation method.According to the X-ray film at the last follow-up,Eaton-Littler staging was used to evaluate the incidence of traumatic arthritis.Results All the patients were follow-up for 12 to 24 months,with an average of 15.4 months.Bone healing was observed in all patients,with the healing time of 5.0 to 7.8 weeks(average,6.2 weeks)in group A and 5.2 to 8.4 weeks(average,6.5 weeks)in group B.The operation time of group A was 15 to 35 minutes with an average of(21.3±0.3)min,while that of group B was 30 to 45 minutes with an average of(38.5±0.2)min.At the last follow-up,the VAS score was(0.85±0.05)points in group A and(0.72±0.04)points in group B.There was no significant difference in flexion/extension ROM,adduction/abduction ROM and grip strength between the two groups(P>0.05).According to TAM system evaluation method,the excellent and good rate was 90.4%in group A and 88.2%in group B.Traumatic arthritis was evaluated by Eaton-Littler staging:for group A,3 cases were in stageⅠand 1 case in stageⅡ;for Group B,1 case was in stageⅠ.Conclusion Both methods can get satisfactory results.The operation time of improved closed reduction percutaneous internal fixation is shorter,but the possibility of traumatic arthritis is greater.