本文選題：第掌骨基底部骨折脫位 + 橈背側(cè)韌帶��； 參考：《中國(guó)修復(fù)重建外科雜志》2017年06期

【摘要】：目的總結(jié)手術(shù)治療陳舊性第1掌骨基底部骨折脫位(Bennett骨折)療效。方法 2012年2月—2015年3月,采用韌帶松解聯(lián)合克氏針固定方法治療10例陳舊性Bennett骨折患者。其中男8例,女2例;年齡24~44歲,平均35.3歲。傷后至手術(shù)時(shí)間為5~14周,平均7.5周。術(shù)前拇示指捏力為1~3級(jí),平均1.8級(jí)。術(shù)后石膏外固定4~8周,骨折愈合后去除克氏針,期間在康復(fù)師指導(dǎo)下進(jìn)行功能鍛煉。結(jié)果術(shù)后切口均Ⅰ期愈合。10例均獲隨訪,隨訪時(shí)間7~16個(gè)月,平均12.5個(gè)月。X線片及CT檢查示第1腕掌關(guān)節(jié)對(duì)位好,無(wú)再脫位發(fā)生;骨折均愈合,愈合時(shí)間2~4個(gè)月,平均3.5個(gè)月。1例傷后14周手術(shù)患者,術(shù)后第1腕掌關(guān)節(jié)仍存在持續(xù)疼痛癥狀,X線片檢查見(jiàn)關(guān)節(jié)毛糙、間隙變窄,證實(shí)第1腕掌關(guān)節(jié)炎形成;其余患者無(wú)關(guān)節(jié)炎發(fā)生,第1腕掌關(guān)節(jié)處無(wú)明顯疼痛,關(guān)節(jié)穩(wěn)定。末次隨訪時(shí),拇示指捏力為3~12級(jí),平均6.8級(jí)。根據(jù)手指關(guān)節(jié)總活動(dòng)度(TAM)系統(tǒng)評(píng)定方法評(píng)價(jià)療效,優(yōu)7例,良2例,差1例,優(yōu)良率90%。結(jié)論對(duì)于陳舊性Bennett骨折,通過(guò)適當(dāng)松解橈背側(cè)韌帶聯(lián)合克氏針內(nèi)固定治療,可取得良好療效。
[Abstract]:Objective to summarize the effect of surgical treatment of old first metacarpal base fracture and dislocation (Bennett fracture). Methods from February 2012 to March 2015, 10 patients with old Bennett fractures were treated with ligamentolysis combined with Kirschner's needle fixation. There were 8 males and 2 females, aged 2444 years with an average age of 35.3 years. The time from injury to operation was 5 ~ 14 weeks with an average of 7.5 weeks. Preoperative thumb finger pinch force was 1 ~ 3 grade, average 1.8 grade. After 4 weeks of external plaster fixation, Kirschner needle was removed after fracture healing, and functional exercise was carried out under the guidance of the rehabilitator. Results all the patients were followed up for 7 ~ 16 months (mean 12.5 months) and CT examination showed that the first carpal metacarpal joint had no redislocation, and the fracture healed for 2 ~ 4 months. In an average of 3.5 months, there were still persistent pain symptoms in the first wrist metacarpal joint. X-ray examination showed that the joint was rough and the gap narrowed, which confirmed the formation of the first wrist metacarpal arthritis, and no arthritis occurred in the other patients. There was no obvious pain in the first wrist-metacarpal joint and the joint was stable. At the last follow-up, the pinch force of thumb finger was 3 ~ 12 grade, with an average of 6.8 grade. According to the total motion of finger joint, TAM system was used to evaluate the curative effect in 7 cases of excellent, 2 cases of good, 1 case of poor, and 90% of excellent and good. Conclusion the treatment of old Bennett fracture with appropriate release of dorsal radial ligament and Kirschner's needle fixation can obtain good curative effect.
【作者單位】： 唐山市第二醫(yī)院手二科唐山市第二醫(yī)院解剖學(xué)教研室;
【分類號(hào)】：R687.3

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