关节镜辅助下经皮螺钉内固定治疗Bennett骨折
|
摘要
目的探讨关节镜辅助下经皮螺钉内固定治疗Bennett骨折的临床疗效、影像学结果和并发症。方法 2009年5月—2015年5月,采用关节镜辅助下经皮螺钉内固定治疗Bennett骨折患者51例(51手),其中男性40例,女性11例;年龄(38.7±12.4)岁;体重指数(23.7±8.1)kg/m2。记录并评估并发症发生率、骨折愈合时间、第一腕掌关节有效活动度评分(Kapandji Score)、握力、捏力、关节面复位及内固定移位情况等。结果 51例患者均获得随访,随访时间(33.8±9.9)个月。骨折愈合时间为(5.9±1.8)周;第一腕掌关节有效活动度评分为(9.8±0.2)分;握力为(46.7±4.2)kg;捏力为(8.7±2.4)kg。所有患者均恢复创伤前工作状态,随访期间1例(2.0%)患者出现复杂性局部疼痛综合征,但不影响日常工作。术后即刻X线片检查,所有关节面均获得解剖复位,随访检查示所有骨折均获得骨性愈合,无一例患者出现关节退变及内固定移位。结论采用关节镜辅助下经皮内固定治疗Bennett骨折,能够获得解剖复位,临床疗效和影像学结果满意,并发症发生率低。
Objective To summarize the clinical,radiographic outcomes and complications of arthroscopically-assisted minimally invasive percutaneous screw fixation in treating Bennett fractures. Methods Fifty-one patients( 51 hands) with Bennett fractures were treated by arthroscopically-assisted minimally invasive percutaneous screw fixation between May 2009 and May 2015. There were 40 males and 11 females,with a mean age of( 38. 7 ±12. 4) years and a mean body mass index of( 23. 7 ± 8. 1) kg/m2. The data was recorded,including the incidence of complications,fracture union time,Kapandji Score for clinical function,grip and pinch strength,joint surface reduction,and displacement of fixation material. Results All of 51 patients were followed up,and the mean follow-up time was( 33. 8 ± 9. 9) months. The mean fracture union time was( 5. 9 ± 1. 8) weeks. The mean Kapandji Score was( 9. 8 ± 0. 2) points; and the mean grip and pinch strength was( 46. 7 ± 4. 2) kg and( 8. 7 ± 2. 4) kg,respectively. All patients recovered pre-traumatic work activities. One patient( 2. 0%) experienced a complex local pain syndrome during follow-up,but did not affect daily work. Immediate postoperative X-ray images showed that all patients achieved anatomic reduction of joint surfaces. All fractures obtained bone union,and no patient had joint degeneration or displacement of screw. Conclusion The arthroscopically-assisted minimally invasive percutaneous screw fixation for Bennett fractures can achieve anatomic reduction of joint surfaces,satisfactory clinical and radiological outcomes,and a low rate of complication.
Objective To summarize the clinical,radiographic outcomes and complications of arthroscopically-assisted minimally invasive percutaneous screw fixation in treating Bennett fractures. Methods Fifty-one patients( 51 hands) with Bennett fractures were treated by arthroscopically-assisted minimally invasive percutaneous screw fixation between May 2009 and May 2015. There were 40 males and 11 females,with a mean age of( 38. 7 ±12. 4) years and a mean body mass index of( 23. 7 ± 8. 1) kg/m2. The data was recorded,including the incidence of complications,fracture union time,Kapandji Score for clinical function,grip and pinch strength,joint surface reduction,and displacement of fixation material. Results All of 51 patients were followed up,and the mean follow-up time was( 33. 8 ± 9. 9) months. The mean fracture union time was( 5. 9 ± 1. 8) weeks. The mean Kapandji Score was( 9. 8 ± 0. 2) points; and the mean grip and pinch strength was( 46. 7 ± 4. 2) kg and( 8. 7 ± 2. 4) kg,respectively. All patients recovered pre-traumatic work activities. One patient( 2. 0%) experienced a complex local pain syndrome during follow-up,but did not affect daily work. Immediate postoperative X-ray images showed that all patients achieved anatomic reduction of joint surfaces. All fractures obtained bone union,and no patient had joint degeneration or displacement of screw. Conclusion The arthroscopically-assisted minimally invasive percutaneous screw fixation for Bennett fractures can achieve anatomic reduction of joint surfaces,satisfactory clinical and radiological outcomes,and a low rate of complication.
引文
[1]Greeven AP,Alta TD,Scholtens RE,et al.Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal[J].Injury,2012,43(2):246-251.
[2]曾伟福,唐光明.闭合复位交叉克氏针固定治疗Bennett骨折手术体会[J].创伤外科杂志,2013,15(3):236.
[3]刘军,陈峰,杨辰,等.加压骨钢针治疗第一掌骨基底部骨折[J].创伤外科杂志,2016,18(1):48-49.
[4]胡爱心,金涛,谭晓毅,等.经尺背侧入路联合桡背侧辅助切口Herbert螺钉固定治疗Bennett骨折[J].中华创伤骨科杂志,2015,17(7):638-640.
[5]Culp RW,Johnson JW.Arthroscopically assisted percutaneous fixation of Bennett fractures[J].J Hand Surg(Am),2010,35(1):137-140.
[6]Pomares G,Strugarek-Lecoanet C,Dap F,et al.Bennett fracture:arthroscopically assisted percutaneous screw fixation versus open surgery:functional and radiological outcomes[J].Orthop Traumatol Surg Res,2016,102(3):357-361.
[7]孙磊,徐军,田军,等.Bennett骨折修复:植入物选择的适宜原则及进展[J].中国组织工程研究,2014,18(44):7199-7204.
[8]刘德淮,庄小强,白宇,等.经皮克氏针固定微创治疗Bennett骨折[J].实用骨科杂志,2014,20(3):278-280.
[9]郭锋,陈棉智,李永军,等.手法闭合复位联合经皮克氏针交叉内固定治疗Bennett骨折[J].中国骨科临床与基础研究杂志,2015,8(3):169-172.
[10]黄晖,庄小强,白宇,等.微型外固定架治疗第1掌骨基底部骨折[J].临床骨科杂志,2013,16(1):104-105.
[2]曾伟福,唐光明.闭合复位交叉克氏针固定治疗Bennett骨折手术体会[J].创伤外科杂志,2013,15(3):236.
[3]刘军,陈峰,杨辰,等.加压骨钢针治疗第一掌骨基底部骨折[J].创伤外科杂志,2016,18(1):48-49.
[4]胡爱心,金涛,谭晓毅,等.经尺背侧入路联合桡背侧辅助切口Herbert螺钉固定治疗Bennett骨折[J].中华创伤骨科杂志,2015,17(7):638-640.
[5]Culp RW,Johnson JW.Arthroscopically assisted percutaneous fixation of Bennett fractures[J].J Hand Surg(Am),2010,35(1):137-140.
[6]Pomares G,Strugarek-Lecoanet C,Dap F,et al.Bennett fracture:arthroscopically assisted percutaneous screw fixation versus open surgery:functional and radiological outcomes[J].Orthop Traumatol Surg Res,2016,102(3):357-361.
[7]孙磊,徐军,田军,等.Bennett骨折修复:植入物选择的适宜原则及进展[J].中国组织工程研究,2014,18(44):7199-7204.
[8]刘德淮,庄小强,白宇,等.经皮克氏针固定微创治疗Bennett骨折[J].实用骨科杂志,2014,20(3):278-280.
[9]郭锋,陈棉智,李永军,等.手法闭合复位联合经皮克氏针交叉内固定治疗Bennett骨折[J].中国骨科临床与基础研究杂志,2015,8(3):169-172.
[10]黄晖,庄小强,白宇,等.微型外固定架治疗第1掌骨基底部骨折[J].临床骨科杂志,2013,16(1):104-105.