不同微创方法治疗第5掌骨颈部骨折的疗效分析

Analysis of three minimally invasive methods in the treatment of the fifth metacarpal neck fracture

目的:探讨手法复位克氏针微创治疗第5掌骨颈部骨折的有效方法。方法:自2018年1月至2021年11月采用手法闭合复位克氏针微创治疗第5掌骨颈部闭合性骨折患者90例,骨折AO分型均为A型。根据克氏针内固定方式分为3组:交叉克氏针组30例,横向克氏针组30例,髓内克氏针组30例,各组性别、年龄、病程、术前颈干角等基线资料比较差异无统计学意义(P>0.05)。观察并比较各组患者术后12个月第5掌骨颈干角、第5掌指关节屈曲活动度和第5掌指关节伸直欠伸角度。根据手-前臂手术疗效评分系统(patient outcomes of surgery-hand/arm,POS-Hand/Arm)进行临床疗效评价。结果:所有患者获得术后12个月随访,均骨性愈合,无畸形愈合。3组患者术后12个月第5掌骨颈干角和掌指关节屈曲角度、掌指关节伸指欠伸角度组间比较,差异无统计学意义(P>0.05)。术后12个月3组POS-Hand/Arm评分中身体活动和症状评分比较差异无统计学意义(P>0.05);心理状况和美观评分:3组比较差异有统计学意义(P<0.05),交叉克氏针组和横向克氏针组比较差异无统计学意义(P>0.05)。术后12个月POS-Hand/Arm总评分:3组比较差异有统计学意义(P<0.05),交叉克氏针组和横向克氏针组比较差异无统计学意义(P>0.05),髓内克氏针组患者POS-Hand/Arm总评分最高。结论:三种克氏针固定技术均能达到微创治疗的目的,患者对美容和早期活动有需求,推荐手法复位克氏针微创髓内固定为首选术式。

Objective To explore the effective method of applying Chinese medicine manipulative repositioning Kirschner wire fixation for minimally invasive treatment of fractures of the neck of the fifth metacarpal.Methods From January 2018 to November 2021,90 patients with closed fractures of the neck of the fifth metacarpal bone were treated minimally invasively with closed repositioning Kirschner wires,all fractures AO type was type A.All patients were divided into three groups according to the mode of internal fixation involving 30 cases in the crossed Kirschner's wire group,30 cases in the transverse Kirschner's wire group,30 patients in the intramedullary Kirschner's wire group.By comparison,gender,age,disease duration,and preoperative neck-stem angle were not significant.The postoperative fifth metacarpal neck-stem angles,postoperative fifth metacarpophalangeal joint flexion mobility and fifth metacarpophalangeal joint extension hyperextension angles were compared among three groups.The overall clinical efficacy was evaluated according to the patient outcomes of surgery-hand/arm(POS-Hand/Arm)scoring system.Results All patients had 12-month follow-up and achieved bony union without malunion.There was no significant difference in the 5th metacarpal neck-stem angle,the fifth metacarpophalangeal joint flexion angle and the fifth metacarpophalangeal joint extension hyperextension angles among three groups at 12 months after surgery(P>0.05).There was no significant difference in physical activity and symptom scores in POS-Hand/Arm scores at 12 months after surgery(P>0.05),psychological status and aesthetic score among three groups(P<0.05)and between cross and transverse Kirschner wire groups(P>0.05).The three POS-Hand/Arm total scores were statistically different(P<0.05),between the crossed and transverse(P>0.05),and the intramedullary group had the highest POS-Hand/Arm scores.Conclusion All three techniques of Kristener's wire fixation could achieve minimally invasive treatment,and patients have need for cosmetic and early activity,and the author recommend minimally invasive intramedullary fixation with manipulative repositioned Kristen wires as the preferred procedure.