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[1]林勇,羅偉斌,葉前驅(qū),等.閉合復(fù)位全螺紋空心加壓螺釘內(nèi)固定與切開復(fù)位鋼板螺釘內(nèi)固定治療Bennett骨折的對(duì)比研究[J].中醫(yī)正骨,2022,34(01):41-46.
　LIN Yong,LUO Weibin,YE Qianqu,et al.A comparative study of closed reduction and full-thread hollow compression screws internal fixation versus open reduction and plate-screws internal fixation for treatment of Bennett fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(01):41-46.
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閉合復(fù)位全螺紋空心加壓螺釘內(nèi)固定與切開復(fù)位鋼板螺釘內(nèi)固定治療Bennett骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年01期
頁(yè)碼:
41-46
欄目:
臨床研究
出版日期:
2022-01-20

文章信息/Info

Title:
A comparative study of closed reduction and full-thread hollow compression screws internal fixation versus open reduction and plate-screws internal fixation for treatment of Bennett fractures
作者:
林勇1; 羅偉斌1; 葉前驅(qū)1; 曾廣輝1; 阮張濤1; 曾秋濤1; 周馳2
(1.廣東醫(yī)科大學(xué)附屬第三醫(yī)院/佛山市順德區(qū)龍江醫(yī)院,廣東 佛山 528318; 2.廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院,廣東 廣州 510405)
Author(s):
LIN Yong1; LUO Weibin1; YE Qianqu1; ZENG Guanghui1; RUAN Zhangtao1; ZENG Qiutao1; ZHOU Chi2
1.The Third Affiliated Hospital of Guangdong Medical University(Shunde Longjiang Hospital),Foshan 528318,Guangdong,China;2.The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China
關(guān)鍵詞:
掌骨;  腕掌關(guān)節(jié);  骨折脫位;  骨折固定術(shù); 內(nèi);  骨螺絲;  Bennett骨折;  臨床試驗(yàn)
Keywords:
metacarpal bones;  carpometacarpal joints;  fracture dislocation;  fracture fixation; internal;  bone screws;  Bennett fractures;  clinical trial
摘要:
目的:比較閉合復(fù)位全螺紋空心加壓螺釘內(nèi)固定與切開復(fù)位鋼板螺釘內(nèi)固定治療Bennett骨折的臨床療效及安全性。方法:回顧性分析2015年1月至2020年1月收治的43例Bennett骨折患者的病例資料,采用閉合復(fù)位全螺紋空心加壓螺釘內(nèi)固定治療者20例(空心加壓螺釘組),采用切開復(fù)位鋼板螺釘內(nèi)固定治療者23例(鋼板螺釘組)。比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、骨折愈合時(shí)間、采用拇指功能評(píng)價(jià)標(biāo)準(zhǔn)評(píng)價(jià)的患側(cè)拇指功能、采用Hotchkiss骨折與關(guān)節(jié)移位標(biāo)準(zhǔn)評(píng)價(jià)的第一腕掌關(guān)節(jié)面恢復(fù)情況、采用上肢功能障礙(disabilities of the arm,shoulder and hand,DASH)評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)的綜合療效以及并發(fā)癥發(fā)生情況。結(jié)果:①一般指標(biāo)。2組患者手術(shù)時(shí)間、術(shù)中出血量及骨折愈合時(shí)間比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(39.30±5.63)min,(38.87±5.00)min,t=0.266,P=0.792;(30.85±4.71)mL,(29.91±5.49)mL,t=0.596,P=0.554;(6.95±1.43)周,(7.04±1.36)周,t=-0.219,P=0.828]。②拇指功能。術(shù)后6個(gè)月,空心加壓螺釘組的拇指功能優(yōu)16例、良3例、差1例,鋼板螺釘組的拇指功能優(yōu)11例、良9例、差3例,空心加壓螺釘組的拇指功能優(yōu)于鋼板螺釘組(Z=-2.108,P=0.035)。③第一腕掌關(guān)節(jié)面恢復(fù)情況。術(shù)后12個(gè)月,空心加壓螺釘組的第一腕掌關(guān)節(jié)面恢復(fù)情況優(yōu)17例、良2例、差1例,鋼板螺釘組的第一腕掌關(guān)節(jié)面恢復(fù)情況優(yōu)12例、良9例、差2例,空心加壓螺釘組的第一腕掌關(guān)節(jié)面恢復(fù)情況優(yōu)于鋼板螺釘組(Z=-2.161,P=0.031)。④DASH評(píng)分。時(shí)間因素與分組因素不存在交互效應(yīng)(F=2.198,P=0.118)。2組患者DASH評(píng)分總體比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=-1.607,P=0.110)。手術(shù)前后不同時(shí)間點(diǎn)DASH評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=14.001,P=0.001)。2組DASH評(píng)分隨時(shí)間變化均呈下降趨勢(shì),但2組的下降趨勢(shì)不完全一致。術(shù)前2組患者DASH評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(71.45±6.00)分,(72.52±6.95)分,t=-0.537,P=0.594]。術(shù)后3個(gè)月、6個(gè)月,空心加壓螺釘組的DASH評(píng)分均低于鋼板螺釘組[(56.95±5.94)分,(60.70±5.09)分,t=-2.228,P=0.031;(39.05±5.54)分,(45.78±6.82)分,t=-3.520,P=0.001]。⑤安全性評(píng)價(jià)結(jié)果。空心加壓螺釘組出現(xiàn)1例骨折畸形愈合、1例第一腕掌關(guān)節(jié)創(chuàng)傷性關(guān)節(jié)炎,鋼板螺釘組出現(xiàn)1例切口感染、2例骨折畸形愈合、1例第一腕掌關(guān)節(jié)創(chuàng)傷性關(guān)節(jié)炎、1例第一腕掌關(guān)節(jié)半脫位。2組患者并發(fā)癥發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.082,P=0.298)。結(jié)論:閉合復(fù)位全螺紋空心加壓螺釘內(nèi)固定與切開復(fù)位鋼板螺釘內(nèi)固定治療Bennett骨折,兩者在手術(shù)時(shí)間、術(shù)中出血量、骨折愈合時(shí)間及并發(fā)癥發(fā)生率方面無(wú)明顯差異,但前者的拇指功能、第一腕掌關(guān)節(jié)面恢復(fù)情況及綜合療效更好。
Abstract:
Objective:To compare the clinical curative effects and safety of closed reduction and full-thread hollow compression screws(HCSs)internal fixation versus open reduction and plate-screws(PSs)internal fixation in treatment of Bennett fractures.Methods:The medical records of 43 patients with Bennett fractures recruited from January 2015 to January 2020 were analyzed retrospectively.Twenty patients were treated with closed reduction and full-thread HCSs internal fixation(HCSs group)and 23 ones with open reduction and PSs internal fixation(PSs group).The operative time,intraoperative blood loss,fracture healing time,function of the injuried thumb evaluated by using thumb function evaluation criteria,recovery of the first carpometacarpal(CMC-1)joint surface assessed by using Hotchkiss fracture and joint displacement criteria,the total clinical curative effects evaluated by using disabilities of the arm,shoulder and hand(DASH)scoring criterion and postoperative complication incidence were compared between the 2 groups.Results:①There was no statistical difference in operative time,intraoperative blood loss and fracture healing time between the 2 groups(39.30±5.63 vs 38.87±5.00 minutes,t=0.266,P=0.792; 30.85±4.71 vs 29.91±5.49 mL,t=0.596,P=0.554; 6.95±1.43 vs 7.04±1.36 weeks,t=-0.219,P=0.828).②The function of the injuried thumbs was evaluated at 6 months after the surgery,and 16 patients obtained an excellent result,3 good and 1 poor in HCSs group; while 11 ones obtained an excellent result,9 good and 3 poor in PSs group.The thumb function was better in HCSs group compared to PSs group(Z=-2.108,P=0.035).③The recovery of the CMC-1 joint surfaces was assessed at 12 months after the surgery,and 17 patients obtained an excellent result,2 good and 1 poor in HCSs group; while 12 ones obtained an excellent result,9 good and 2 poor in PSs group.The recovery of the CMC-1 joint surfaces was better in HCSs group compared to PSs group(Z=-2.161,P=0.031).④There was no interaction between time factor and group factor in DASH scores(F=2.198,P=0.118).There was no statistical difference in DASH scores between the 2 groups in general,in other words,there was no group effect(F=-1.607,P=0.110).There was statistical difference in DASH scores between different timepoints before and after the surgery,in other words,there was time effect(F=14.001,P=0.001).The DASH scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in DASH scores between the 2 groups before the surgery(71.45±6.00 vs 72.52±6.95 points,t=-0.537,P=0.594).The DASH scores were lower in HCSs group compared to PSs group at 3 and 6 months after the surgery(56.95±5.94 vs 60.70±5.09 points,t=-2.228,P=0.031; 39.05±5.54 vs 45.78±6.82 points,t=-3.520,P=0.001).⑤After the surgery,the fracture malunion(1 case)and the CMC-1 joint traumatic osteoarthritis(1 case)were found in HCSs group; whereas the incision infection(1 case),fracture malunion(2 cases),the CMC-1 joint traumatic osteoarthritis(1 case)and the CMC-1 joint subluxation(1 case)were found in PSs group.There was no statistical difference in complication incidences between the 2 groups(χ2=1.082,P=0.298).Conclusion:There is no obvious difference in operative time,intraoperative blood loss,fracture healing time and complication incidence between the therapy of closed reduction and full-thread HCSs internal fixation and the therapy of open reduction and PSs internal fixation in treatment of Bennett fractures,while the former surpasses the latter in thumb function outcome,the CMC-1 joint surface recovery and total clinical curative effects.

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備注/Memo

備注/Memo:
基金項(xiàng)目:佛山市醫(yī)學(xué)類科技攻關(guān)項(xiàng)目(2018AB002023)
通訊作者:曾秋濤 E-mail:[email protected]
更新日期/Last Update: 1900-01-01