[微型双头加压螺钉或联合微型钢板内固定治疗第一掌骨基底部关节内骨折22例分析]双头加压螺钉
[摘要] 目的 探讨微型双头加压螺钉或联合微型钢板内固定治疗第一掌骨基底部关节内骨折的临床疗效。 方法 对22例第一掌骨基底部关节内骨折骨折患者均采用微型双头加压螺钉或联合微型钢板内固定治疗。 结果 22例患者均手术成功，平均手术时间45 min，平均住院时间12 d，疗效评估均为优，随访未出现伸肌腱损伤粘连、切口感染、骨折不愈合或钢板松动脱钉等并发症。 结论 手术切开微型双头加压螺钉或联合微型钢板内固定是第一掌骨基底部关节内骨折的有效治疗手段，值得应用推广。
[关键词] 第一掌骨基底部关节内骨折；微型双头加压螺钉；微型钢板；骨折内固定术
[中图分类号] R683.41 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0053-02
Analysis of 22 cases with intra-articular fracture of the first metacarpal basilar part treated by micro double-headed forcing screw or combined with internal fixation with miniature steel plate
SHENG Yu ZHAO Longdui YANG Qiuna
The First Department of Orthopedics, the Cooperation Hospital of Xiangya and Pingkuang in Jiangxi Province, Pingxiang 337003, China
[Abstract] Objective To explore the clinical curative effect of micro double-headed forcing screw or combined with internal fixation with miniature steel plate in the treatment of intra-articular fracture of the first metacarpal basilar part. Methods Twenty two cases with intra-articular fracture of the first metacarpal basilar part were all taken the treatment of micro double-headed forcing screw or combined with internal fixation with miniature steel plate. Results All of 22 patients had successful operation. The average operation time was 45 min, the average hospitalization time was 12 d, all of the efficacy evaluation was best. There were no injuries and adhesion of extensor tendon, infection of incision, fracture nonunion or steel plate loosening and nail off and other complications after follow-up. Conclusion Surgical incision and micro double-headed forcing screw or combined with internal fixation with miniature steel plate is effective in the intra-articular fracture of the first metacarpal basilar part, is worthy of application and promotion.
[Key words] The intra-articular fracture of the first metacarpal basilar part; Micro double-headed forcing screw; Mini-plate; Internal fixation of fractures
第一掌骨基底部骨折在临床上较为常见，通常为间接暴力所致，可分为关节外和关节内骨折两类。关节外骨折一般采取保守治疗，以手法复位后石膏外固定为主，这类骨折预后较好。关节内骨折分为Bennett骨折和Rolando骨折，保守治疗难以维持复位，常导致骨折畸形愈合，严重影响腕掌关节及拇指关节功能。笔者2009年3月～2012年3月应用微型双头加压螺钉或联合微型钢板内固定治疗第一掌骨基底部关节内骨折22例效果良好，现报道如下：
1 资料与方法
1.1 一般资料
本组第一掌骨基底部骨折患者22例，男16例，女6例，年龄19～51岁，平均33岁。22例均为闭合骨折，其中，Bennett骨折15例，Rolando骨折7例，就诊时间为伤后1 h～2 d，伤后4～6 d内手术。
1.2 治疗方法
采用臂丛神经阻滞麻醉，常规消毒铺巾。从第一掌骨桡侧背面做一弧形切口，在腕横纹处弯向掌侧。部分剥离掌骨干近端软组织，切开腕掌关节，细心保护跨过该处的感觉神经支。暴露骨折，直视下对好关节面，并将骨折复位，用小巾钳做暂时固定，如骨折为Bennett骨折则斜行垂直骨折线打入导针，并注意导针方向，勿使导针通过内侧三角型骨块关节面，并旋入微型双头加压螺钉，术后无需石膏托外固定，术后2～3 d开始功能锻炼；如骨折为Rolando骨折则先将近端纵行骨折复位后，横行垂直骨折线打入导针，旋入微型双头加压螺钉后，再将远端横行骨折复位后，联合使用微型T形钢板将骨折上下端固定，注意近端两枚螺丝钉进入的方向，尾端应偏向远端，尽量避免其进入关节面以免对关节面再次进行破坏。伤口关闭后，用前臂掌侧石膏托将腕关节固定于功能位，拇指充分外展，对掌位，石膏托远端固定位置位于拇指指间关节，并允许指间关节运动，避免拇指掌指关节过伸。术后2周拆除石膏托开始主动的腕掌关节及拇指关节功能活动度练习。