摘要
目的:研究第五掌骨颈骨折屈曲位复位的可行性及过伸复位伸直固定治疗的临床疗效。方法:选择2021年1月至2022年4月就诊的掌骨颈骨折患者55例,尺神经阻滞下先将掌指关节固定于极度屈曲位后拍片,若掌指关节屈曲≥90°,则采用屈曲位复位;若掌指关节屈曲<90°,采用过伸位牵引,用提按手法复位并用夹板三点加压结合石膏固定,观察屈曲位复位的可行性及过伸位复位伸直固定最终的复位效果、再移位情况及功能恢复情况。结果:本组病例可以采用屈曲位复位的患者5例,占总数的0.09%。采用过伸复位伸直固定治疗的50例,过伸位复位固定中复位后解剖对位44例,功能复位6例,解剖复位率为88%。未再移位42例,再移位后仍符合功能复位标准8例,未再移位率为84%。手部功能恢复情况,优47例,良3例,差0例,优良率为100%。均未出现酸痛不适、影响日常生活或被迫改变职业工种的情况。结论:掌骨颈骨折后因局部软组织肿胀及背侧软组织绞链破坏,只有少部分患者伤后掌指关节可以有效屈曲≥90°,客观上存在无法实现屈曲位复位的操作,而采用过伸复位伸直位固定是一种更为容易实现的临床操作,值得在临床中大力推广应用。
Objective:To study the feasibility of flexion reduction of the fifth metacarpal neck fracture and the clinical efficacy of hyperextension reduction and extension fixation. Methods:55 patients with metacarpal neck fractures were selected from January 2021 to April 2022. Under ulnar nerve block, the metacarpophalangeal joints were first fixed in the extreme flexion position and then radiographs were taken. If the metacarpophalangeal joints were flexed ≥90°, flexion reduction was used. If the metacarpophalangeal joint was flexed <90°, hyperextension traction was used, and the lifting and pressing manipulation was used for reduction and three-point compression with splint combined with plaster fixation. The feasibility of flexion reduction and the hyperextension reduction and straightening fixation, the final reset efficacy re-displacement and functional recovery were observed. Results:The results of the study showed that the 55 cases in this group, 5 patients were treated with flexion reduction, accounting for 0.09% of the total, and 50 patients were treated with hyperextension reduction and extension fixation. There were 44 cases of repositioning, 6 cases of functional reduction, the anatomical reduction rate was 88%. 42 cases were not re-displaced, 8 cases still met the functional reduction standard after re-displacement, the non-re-displacement rate was 84%. The recovery of hand function was excellent 47, there were 3 good cases and 0 poor cases, and the excellent and good rate was 100%. There was no soreness and discomfort, affecting daily life or being forced to change occupations. Conclusion:After metacarpal neck fracture, due to local soft tissue swelling and dorsal soft tissue hinge damage, only a small number of patients can effectively flex the metacarpophalangeal joint ≥ 90° after injury, so there is an objective operation that cannot achieve flexion reduction, and hyperextension reduction and extension are used. Straight fixation is a easy clinical operation, and it is worthy of vigorous promotion in clinical practice.
作者
郑晓蓉
吴小宝
林锋山
林志强
叶若凡
王振盛
萧庆瑞
陈永海
吴振斌
ZHENG Xiaorong;WU Xiaobao;LIN Fengshan;LIN Zhiqiang;YE Ruofan;WANG Zhensheng;XIAO Qingrui;CHEN Yonghai;WU Zhenbin(Quanzhou Orthopaedic Hospital,Quanzhou 362000,Fujian China)
出处
《中国中医骨伤科杂志》
CAS
2023年第2期58-60,65,共4页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
过伸位
牵引
整复
掌骨颈骨折
hyperextension
traction
restoration
metacarpal neck fracture
