单根髓内克氏针固定第5掌骨颈再骨折

Single intramedullary Kirschner wire for fixation of re-fracture of the fifth metacarpal neck

摘要:

[目的] 探讨单根髓内克氏针固定治疗第 5 掌骨颈骨折临床骨折愈合内固定取出后再骨折的临床疗效。[方法] 2015 年 1 月—2021 年 6 月应用单根顺行 2.0 mm 髓内克氏针固定治疗第 5 掌骨颈骨折再骨折 10 例。总结围手术期、随访及影像资料。[结果]所有患者顺利完成手术，手术时间平均(18.60±2.88)min，术中微量出血， 所有患者切口均愈合良好。随访时间平均 (4.90±1.10) 个月，术后随着时间推移，VAS、DASH 评分显著降低 (P＜0.05)，第五掌指 ROM 显著增加 (P＜ 0.05)，随访过程中发现 1 例克氏针突破软骨下骨进入关节约 2 mm，未完全制动，随访 5 个月骨折临床愈合。影像方面，与术前相比，术后 3 个月、末次随访时骨折复位对位、对线均显著改善 (P＜0.05)。末次随访骨折全部愈合，无内固定失效、松动、移位或断裂，无骨不连、畸形愈合等并发症。[结论]单根髓内克氏针固定治疗第 5 掌骨颈再骨折临床疗效满意。

Abstract:

[Objective] To evaluate the clinical outcomes of single intramedullary Kirschner wire for fixation of re-fracture of the fifth metacarpal neck secondary to primary internal fixation. [Methods] From January 2015 to June 2021, 10 patients received internal fixa- tion with a single 2.0 mm intramedullary Kirschner wire for re-fracture of the fifth metacarpal neck. The perioperative, follow-up and imag- ing data were summarized. [Results] All studied patients had operation completed successfully with operation time of (18.60±2.88) min, whereas without serious complications such as reduction loss, infection, bone nonunion, tendon stimulation and joint stiffness. As time went in follow-up lasted for 3~6 months with a mean of (4.90±1.10) months, VAS and DASH scores, as well as metacarpophalangeal range of mo- tion (ROM) significantly improved (P＜0.05) . Radiographically, the excellent fracture reduction at 3 months after operation and the last fol- low-up was 90%, additionally, fracture healing achieved in 40% at 3 months, while 100% at the last follow-up (P＜0.05) . [Conclusion] The single intramedullary Kirschner wire fixation for re-fracture of fifth metacarpal neck does achieve satisfactory clinical consequences.