[1]郑晓蓉△,吴小宝,林锋山,等.过伸复位伸直固定治疗第五掌骨颈骨折[J].中国中医骨伤科杂志,2023,31(02):58-60+65.
　ZHENG Xiaorong WU Xiaobao LIN Fengshan LIN Zhiqiang YE Ruofan WANG Zhensheng XIAO Qingrui CHEN Yonghai WU Zhenbin.Hyperextension Reduction and Straightening Fixation on the Treatment of the Fifth Metacarpal Neck Fracture[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(02):58-60+65.
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过伸复位伸直固定治疗第五掌骨颈骨折()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年02期
页码:
58-60+65
栏目:
临床报道
出版日期:
2023-02-15

文章信息/Info

Title:
Hyperextension Reduction and Straightening Fixation on the Treatment of the Fifth Metacarpal Neck Fracture
文章编号:
1005-0205(2023)02-0058-03
作者:
郑晓蓉1△; 吴小宝1; 林锋山1; 林志强1; 叶若凡1; 王振盛1; 萧庆瑞1; 陈永海1; 吴振斌1
1泉州市正骨医院(福建 泉州,362000)
Author(s):
ZHENG Xiaorong1△ WU Xiaobao1 LIN Fengshan1 LIN Zhiqiang1 YE Ruofan1 WANG Zhensheng1 XIAO Qingrui1 CHEN Yonghai1 WU Zhenbin1
1Quanzhou Orthopaedic Hospital, Quanzhou 362000, Fujian China.
关键词:
过伸位;  牵引;  整复;  掌骨颈骨折
Keywords:
hyperextension;  traction;  restoration;  metacarpal neck fracture
分类号:
R683.41
文献标志码:
B
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。
Abstract:
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.

参考文献/References:

[1] 田光磊,王澍寰.骨与关节损伤[M].2版.北京:人民卫生出版社,1999:209-355.
[2] 王澍寰.手外科学[M].2版.北京:人民卫生出版社,1999:269.
[3] 裘法祖.外科学[M].4版.北京:人民卫生出版社,1997:766.
[4] 王永渝.中医正骨学[M].41版.北京:人民卫生出版社,2005:105-106.
[5] 周骥,王友彬,陈洪涯.石膏指夹板外固定治疗第五掌骨颈骨折的探讨[J].中外医学研究,2020,18(2):122-123.
[6] 刘凯,叶永亮,王广伟,等.自制夹板外固定治疗掌骨骨折的临床疗效观察[J].中国骨伤,2021,34(6):568-572.
[7] 王孝辉,张彩丽,沈素红,等.超声引导下手法复位牵引托板固定治疗掌骨颈骨折[J].中国骨伤,2018,31(3):254-256.
[8] 潘生德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[9] AMSALLEM L,PIERRART J,BIHEL T,et al.Simplified internal fixation of fifth metacarpal neck fractures[J].Orthop Traumatol Surg Res,2018,104(2):257-260.
[10] HUSSAIN M H,GHAFFAR A,CHOUDRY Q,et al. Management of fifth metacarpal neck fracture(Boxer's fracture):a literature review[J].Cureus,2020,12(7):e9442.
[11] LEE S J,MERRISON H,WILLIAMS K A,et al.Closed reduction and immobilization of pediatric fifth metacarpal neck fractures[J]. Hand(NY),2022,17(3):416-421.
[12] 倪净.手法复位联合双重夹板过伸位固定治疗第五掌骨颈骨折伴掌指关节半脱位36例[J].江苏中医药,2015,47(10):46-47.
[13] 程德彪.AO微型锁定髁钢板治疗第五掌骨颈骨折的疗效观察[J].航空航天医学杂志,2021,32(4):439-440.
[14] 明立功,明朝戈,王自方,等.经皮克氏针横行平行或交叉支撑固定治疗第五掌骨颈骨折[J].中国修复重建外科杂志,2020,34(2):272-274.
[15] 张来福,吕亚庆,卢承印,等.高频超声引导下弹性髓内钉固定治疗第五掌骨颈骨折[J].中国修复重建外科杂志,2021,35(2):154-159.
[16] 明新广,明立功,明朝戈,等.经皮掌骨易折针横行支撑固定治疗第5掌骨颈骨折[J].实用手外科杂志,2021,35(3):333-335.
[17] 王英,王丹红,颜崇县,等.闭合复位克氏针横行固定第5掌骨颈骨折的疗效研究[J].浙江创伤外科,2020,25(6):1197-1199.
[18] 唐俊华,金国栋,曾永文等.闭合复位髓内针联合克氏针交叉内固定治疗掌骨骨折34例[J].中国中医骨伤科杂志,2020,28(8):58-60.
[19] ZHU H,XU Z,WEI H,et al.Locking plate alone versus in combination with two crossed Kirschner wires for fifth metacarpal neck fracture[J].Sci Rep,2017,7:46109.
[20] BOECKSTYNS M E H.Challenging the dogma:severely angulated neck fractures of the fifth metacarpal must be treated surgically[J].J Hand Surg Eur Vol,2021,46(1):30-36.
[21] 鲍树仁,伸直位整复固定治疗第5掌骨颈骨折[J].中国骨伤,2002,15(5):293.
[22] 王亦聪.骨与关节损伤[J].3版.北京:人民卫生出版社,2001:78.

备注/Memo

备注/Memo:
△通信作者 E-mail:zfkzxr77@126.com
更新日期/Last Update: 2023-02-10