自制小夹板外固定治疗第一掌骨基底部骨折脱位疗效观察

Effect of self-made small splint external fixation in the treatment of fracture and dislocation of the base of the first metacarpal bone

目的研究自制小夹板外固定治疗第一掌骨基底部骨折脱位的治疗效果及其临床应用价值。方法前瞻性选取2020年1月至2021年1月间河源市华信泰康医院骨科收治的80例第一掌骨基底部骨折脱位患者作为研究对象,按随机数表法将患者分为观察组和对照组,每组40例。两组患者均采用手法复位,复位完成后观察组患者采用自制小夹板外固定治疗,对照组患者采用石膏外固定治疗。于手术完成后12周对患者进行随访,采用总主动活动度(TAM)评分系统评价两组患者的治疗效果,并以Sälgeback评价法比较两组患者治疗后的主观感受,同时比较两组患者治疗后的关节屈伸活动度(ROM)和握力,以及术后12周内的并发症发生情况。结果治疗完成12周后,观察组患者的患侧手部TAM评分优良率为92.50%,明显高于对照组的75.00%,差异有统计学意义(P<0.05);两组患者的主观感受比较差异无统计学意义(P>0.05);治疗12周后,观察组患者的患侧第一腕掌关节屈伸ROM、拇指外展ROM和握力与同组健侧比较差异均无统计学意义(P>0.05),而对照组患者的患侧第一腕掌关节屈伸ROM、拇指外展ROM和握力明显低于同组健侧,差异均有统计学意义(P<0.05);治疗12周后,观察组患者患侧第一腕掌ROM为(46.58±6.14)°,明显高于对照组的(41.57±5.98)°,患侧拇指外展ROM为(48.90±5.22)°,明显高于对照组的(43.63±7.58)°,患侧握力为(32.61±4.29)kg,明显高于对照组的(28.94±5.94)kg,差异均有统计学意义(P<0.05);观察组患者的总并发症发生率为5.00%,明显低于对照组的20.00%,差异具有统计学意义(P<0.05)。结论自制小夹板外固定是治疗第一掌骨基底部骨折脱位的有效治疗手段,其具有与传统固定治疗手段相当的临床疗效,同时还能显著改善患者患侧关节的屈伸活动情况,增强手掌握力,且能够一定程度上减少相关并发症的发生。

Objective To study the therapeutic effect and clinical application value of self-made small splint external fixation in the treatment of fracture and dislocation of the base of the first metacarpal bone.Methods Eighty patients with fracture and dislocation of the base of the first metacarpal bone who were admitted to Heyuan Huaxin Taikang Hospital from January 2020 to January 2021 were prospectively selected as the research objects.The patients were divided into an observation group and a control group by random number table method,with 40 patients in each group.Manual reduction was applied to both groups of patients.After reduction,patients in the observation group were treated with self-made small splint external fixation,and those in the control group were treated with plaster external fixation.The patients were all followed up for 12 weeks after the operation,and the total active mobility(TAM)scoring system was used to observe and compare the treatment effects of the two groups.Sälgeback evaluation method was used to compare the subjective feelings of the two groups of patients after treatment.At the same time,the joint flexion and extension range of motion(ROM)and grip strength of the two groups of patients after treatment were collected and compared,as well as the complications within 12 weeks after the operation.Results At 12 weeks after treatment,the excellent and good rate of TAM score of the affected hand in the observation group was 92.50%,which was significantly higher than 75.00%in the control group(P<0.05).There was no significant difference in subjective feelings between the two groups(P>0.05).At 12 weeks after treatment,the flexion and extension ROM,thumb abduction ROM,and grip strength of the affected side of the first carpal metacarpal joint in the observation group were not significantly different from those in the healthy side in the same group(P>0.05);the flexion and extension ROM,thumb abduction ROM,and grip strength of the affected side of the first carpal metacarpal joint in the control group were lower than those of the healthy side in the same group(P<0.05).The ROM of the first carpometacarpal joint in the observation group was(46.58±6.14)°,which was significantly higher than(41.57±5.98)°in the control group;the abduction ROM of the affected thumb was(48.90±5.22)°,which was significantly higher than(43.63±7.58)°of the control group;the grip strength of the affected side was(32.61±4.29)kg,which was significantly higher than(28.94±5.94)kg of the control group;the differences were all statistically significant(P<0.05).The incidence of complications in the observation group was 5.00%,which was significantly lower than 20.00%in the control group(P<0.05).Conclusion Self-made small splint external fixation is an effective treatment for fracture and dislocation of the base of the first metacarpal bone,and it has a clinical effect comparable to traditional fixation.At the same time,it can significantly improve the flexion and extension activities of the affected joint of the patient,enhance the grasp strength of the hand,and can effectively reduce the occur-rence of related complications to a certain extent.