摘要
背景:第五掌骨干骨折在临床上常见,手术治疗多采用切开复位钢板固定,但术后大多数患者要求取出内固定物,需二次住院治疗。经皮克氏针横行固定具有创伤小、切口小、不需再次住院手术取出等优点,但对第五掌骨干骨折的应用效果不明确。目的:对比分析经皮克氏针横行固定与微型钢板置入治疗第五掌骨干骨折的临床疗效。方法:回顾性分析滨州医学院附属医院在2018年5月至2020年5月收治的第五掌骨干骨折并行手术治疗患者60例,根据治疗方式分为2组,钢板组30例采用切开复位微型钢板内固定置入治疗,克氏针组30例采用闭合复位经皮克氏针横行固定(其中5例小切口切开辅助)治疗。比较两组患者的住院时间、手术时间、切口愈合等级、手术切口长度、术中出血量、术中透视次数及术后并发症的发生情况,记录两组患者骨折愈合时间、握力、第五掌指关节活动度等,采用中华医学会手外科学会手指关节总活动度法评估患者的手指功能。结果与结论:①两组患者均获得随访,随访时间13-18个月;两组患者住院时间、手术时间、切口愈合等级相比差异无显著性意义(P>0.05);②克氏针组术中出血量、手术切口长度均小于钢板组(P<0.05),钢板组术中透视次数少于克氏针组(P<0.05),两组骨折愈合时间比较差异无显著性意义(P>0.05);③末次随访时,依据手指关节总活动度法评估疗效,克氏针组优良率为87%,钢板组优良率为90%,两组比较差异无显著性意义;两组末次随访的第五掌指关节活动度、握力比较差异无显著性意义(P>0.05);④克氏针组术后有1例发生钉道感染,周围略有红肿,给予碘伏加强换药后感染得到控制;1例出现针尾刺激皮肤症状,拔除克氏针后症状消失;钢板组有12例因个人原因于术后12个月以后住院行钢板取出术,克氏针组全都在门诊取出;钢板组出现3例第五掌骨远端背侧及小指指背侧皮肤感觉麻木,术后口服甲钴胺,症状逐渐消失;两组均未出现骨不愈合及内固定取出再骨折等情况;⑤结果表明,这两种术式治疗第五掌骨干骨折均获得良好疗效,手指功能恢复佳,但经皮克氏针横行固定具有创伤小、切口小、费用低、内固定取出方便等优点。
BACKGROUND:Fractures of the fifth metacarpal shaft are common in the clinic,and surgical treatment is mostly performed with open reduction plate fixation,but postoperatively,most patients require removal of the internal fixation and require secondary hospitalization.Transcutaneous fixation with a Kirschner wire has many advantages,such as less trauma,small incision,and no need for reoperation.OBJECTIVE:To comparatively analyze the clinical efficacy of percutaneous fixation of a Kirschner wire with miniplate placement in the transverse plane for treatment of the fifth metacarpal shaft fracture.METHODS:A total of 60 patients who underwent surgery for the fifth metacarpal shaft fracture at Binzhou Medical University Hospital between May 2018 and May 2020 were retrospectively analyzed and divided into two groups according to the operation method.30 patients in the plate group were treated with open reduction miniplate internal fixation;30 patients in the Kirschner wire group were treated with closed reduction and percutaneous fixation with a Kirschner wire(of which 5 patients were treated with mini-incision incision assisted fixation).The length of hospital stay,operation time,incision healing grade,incision length,intraoperative blood loss,intraoperative fluoroscopy number,and postoperative complications were compared between the two groups.The fracture healing time,grip strength,and the motion range of the fifth metacarpophalangeal joint were recorded in the two groups,and the functional outcomes of the fingers were evaluated by the total active movement method.RESULTS AND CONCLUSION:(1)Patients in both groups were followed up for 13-18 months.The differences in hospital stay,operation time,and incision healing grade between the two groups were not statistically significant(P>0.05).(2)The amount of intraoperative blood loss and incision length in the Kirschner wire group were less than those in the plate group(P<0.05).The number of intraoperative fluoroscopies in the plate group was less than that in the Kirschner wire group(P<0.05).There was no significant difference in the fracture healing time between the two groups(P>0.05).(3)At the last follow-up,the efficacy was evaluated according to the total active movement method.The excellent and good rate was 87%in the Kirschner wire group and 90%in the plate group,with no significant difference.There were no significant differences between the two groups in the motion range and grip strength of the fifth metacarpophalangeal joint at the last follow-up(P>0.05).(4)Pin tract infection occurred in one case after Kirschner wire placement,which improved after giving iodophor to enhance the dressing change.There was 1 case of pin tail irritating skin symptoms,which resolved after the removal of the Kirschner wires.There were 12 patients in the plate group who were hospitalized after 12 months for personal reasons for plate removal,and all in the Kirschner wire group were removed on an outpatient basis.In the plate group,three patients developed sensory numbness of the skin on the dorsal side of the distal fifth metacarpal and the dorsal side of the little finger,which resolved gradually with oral administration of mecobalamin after surgery.There were no instances of nonunion and refracture with internal fixation in either group.(5)Our results showed that both of these surgical procedures achieved good results in the treatment of fifth metacarpal shaft fracture with excellent functional recovery of the fingers,but the transverse fixation with percutaneous Kirschner wire has many advantages,such as less trauma,small incision,low cost,and convenient removal of internal fixation.
作者
张政
张岱捷
李朋
Zhang Zheng;Zhang Daijie;Li Peng(Department of Hand Microsurgery,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China;Department of Orthopedics,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第30期4842-4847,共6页
Chinese Journal of Tissue Engineering Research
基金
山东省自然科学基金青年项目(ZR2020QH071),项目负责人:李朋。
关键词
微型钢板
克氏针
横行固定
第五掌骨干骨折
掌骨骨折
内固定
miniplate
Kirschner wires
transverse fixation
fifth metacarpal shaft fracture
metacarpal fracture
internal fixation
