克氏针固定钩骨体部冠状面骨折

Kirschner wire fixation of coronal fracture of the hamate body

摘要:

[目的] 探讨切开复位克氏针固定钩骨体部骨折的临床效果。[方法] 回顾性分析 2015 年 1 月—2020 年 12 月本院收治的 23 例钩骨体部骨折患者的临床资料，评价临床及影像结果。[结果]所有患者均顺利完成手术，术中均无神经、血管等严重并发症。23 例患者随访（25.0±14.0）个月，随时间推移，患者 VAS 和 DASH 评分显著减少（P＜0.05），腕关节伸-屈活动度及尺偏-桡偏活动度显著增加（P＜0.05）。末次随访患侧握力与健侧差异无统计学意义（P＞0.05）。 影像方面，23 例患者术后影像评估骨折复位质量，优 12 例，良 3 例，可 3 例，差 5 例。骨折影像愈合时间 6~12 周，至末次随访时未见明显腕关节退变征象。[结论]切开复位克氏针内固定治疗钩骨体部冠状面骨折并未增加感染风险，可更好复位关节面，修复损伤组织。

Abstract:

[Objective] To evaluate the clinical outcomes of open reduction and internal fixation (ORIF) with Kirschner wire for hamate body fracture. [Methods] A retrospective study was done on 23 patients who received ORIF with Kirschner wire for hamate body fracture in our hospital from January 2015 to December 2020. The documents regarding clinical and imaging results were evaluated. [Results] All pa- tients were operated on successfully with no serious complications such as neurovascular injuries. With time of follow-up lasted for (25.0± 14.0) months, the VAS and DASH scores decreased significantly (P＜0.05), whereas wrist extension-flexion range of motion (ROM) and ul- nar-radial deviation ROM increased significantly (P＜0.05). In addition, there was no significant difference in grip strength between the af- fected side and the healthy side at the latest follow-up (P＞0.05). In terms of imaging, the quality of fracture reduction assessed by postoper- ative radiographs was excellent in 12 cases, good in 3 cases, fair in 3 cases and poor in 5 cases. The patients got fracture healing from 6 to 12 weeks postoperatively on images without obvious signs of degeneration of wrist joint until the latest follow-up. [Conclusion] Open reduc- tion and internal fixation with Kirschner wire do better reduce the articular surface and repair the damaged tissue without increase of the in- fection risk for coronal fracture of the hamate body.