移位掌骨骨折的手术治疗.DOCVIP

临床医学论文-移位掌骨骨折的手术治疗 ????????????????? 作者：张智，吴小满，闫宝山，赵东升，马远征 【摘要】? 目的 探讨移位掌骨骨折的手术治疗效果。方法 2007年5月至2008年11月，解放军第309医院骨科对采用手术治疗移位掌骨骨折并获得随访68例(76处)患者资料进行分析总结。男52例，女16例，年龄15~52岁，平均30.2岁。单发骨折60例，多发骨折8例。闭合性损伤62例(68处)，开放性骨折6例(8处)，其中2例合并环小指伸肌腱断裂。骨折部位：掌骨颈骨折34例(34处)，掌骨干骨折27例(33处)，基底骨折7例(9处)。采用手术方法切开复位AO微型钢板或单纯AO微型螺钉内固定，术后早期功能锻炼。结果 68例患者随访6~12个月，平均8个月，66例患者伤口一期愈合。2例挤压伤患者发生感染，于术后6周取出钢板并行局部皮瓣转移，感染控制，其中1例(2处)骨折畸形愈合。骨性愈合时间平均为11周(8~12周)。按照手指总主动活动度(total active motion TAM)的评级标准并参考手指总主动屈曲度(total active flexion TAF)的评级标准进行评定，优54例(58处)，良8例(9处)，中4例(6处)，差2例(3处)。优良率为91.2%。结论 切开复位，AO微型钢板或单纯AO微型螺钉内固定是治疗移位掌骨骨折的一种有效方法，早期功能锻炼对功能恢复至关重要。 【关键词】? 掌骨;骨折;骨折固定术 　　[Abstract] Objective To evaluate the outcome of displaced metacarpal fractures with internal fixation.Methods 68 patients(76 lesions)with displaced metacarpal fractures treated with internal fixation from May 2007 to November 2008 were studied retrospectively，including 52 males and 16 females，with an average age of 30.2 years old(ranged from 15～52 years old).They included 60 signal fracture and 8 multi-metacarpal fracture.There were close injuries for 62 cases(68 lesions)and open injuries for 6 cases(8 lesions).The fractures of all cases were treated operatively with open reduction and internal fixation using AO mini-plates or AO mini-screws，and the early motion were performed after operation.Results All the 68 patients followed up for 8 months on average(ranging from 6～12 months).In 66 of all cases，the incisions were healed by first intention and 2 cases infection were found.The malunion was in 1 case(2 lesions).The healing time was 11 weeks(ranging from 8～12 weeks).According to the evaluation of total active motion(TAM)and total active flexion(TAF)scales，the results were excellent in 54 cases(58 lesions)，good in 8 cases(9 lesions)，with 91.2% overall excellent and good rate.Conclusion Open reduction and internal fixation with AO mini-plates or mini-screws is an effective way for treatment of displaced metacarpal fracture.Timely early exercise