第五掌骨颈骨折的Vives固定术——24例

[Vives pinning in L of the fractures of the fifth metacarpal neck--24 cases].

作者信息

Marzouki A, Elmrini A, Elibrahimi A, Boutayeb F

机构信息

Service de chirurgie orthopédique et de traumatologie, hôpital Alghassani, CHU Hassan II, 30000 Fès, Maroc.

出版信息

Chir Main. 2009 Apr;28(2):78-81. doi: 10.1016/j.main.2009.01.004. Epub 2009 Feb 23.

Abstract

Fractures of the neck of the fifth metacarpal (boxer's fracture) represent 20% of all fractures of the hand and are frequently observed in male patients, involve the dominant hand, and very often follow a direct blow or punch. We present a retrospective study of 24 fractures of the neck of the fifth metacarpal, treated by "L" pinning as described by Vives, between January 2004 and January 2008. All the patients were men with a mean age of 30 years (range 18 to 50). The mechanism of injury was dominated by fist strike (18 cases). Surgical treatment was performed in cases of fractures with a mean palmar tilt of 37 degrees (range 30 degrees to 60 degrees ). Pinning with a Vives procedure consisted of inserting two pins in an "L" configuration; the first a centromedullary pin measuring 20mm, the second a transverse one through the fourth metacarpal bone controlling rotation and measuring 12mm. Surgery was performed under loco-regional anaesthesia in 75% of cases, and under general anaesthesia in 25% of cases. No immobilization was recommended. Physiotherapy was performed in all cases. Fracture consolidation was obtained in all cases, and the pins were removed in the 6th week following surgery. This technique of osteosynthesis allowed us to obtain good clinical and radiological results according to the criteria of Frere with a mean follow up of 24 months.

摘要

第五掌骨颈骨折(拳击者骨折)占手部所有骨折的20%,常见于男性患者,多累及优势手,且常因直接打击或拳击所致。我们对2004年1月至2008年1月间采用维韦斯描述的“L”形穿针固定法治疗的24例第五掌骨颈骨折进行了一项回顾性研究。所有患者均为男性,平均年龄30岁(范围18至50岁)。损伤机制以拳击为主(18例)。对于平均掌侧倾斜37度(范围30度至60度)的骨折进行手术治疗。维韦斯手术穿针是将两根针呈“L”形插入;第一根为20毫米的中心髓内针,第二根为穿过第四掌骨控制旋转的12毫米横向针。75%的病例在局部麻醉下进行手术,25%的病例在全身麻醉下进行手术。不建议进行固定。所有病例均进行了物理治疗。所有病例均实现骨折愈合,术后第6周取出钢针。根据弗雷尔标准,平均随访24个月,这种骨固定技术使我们获得了良好的临床和影像学结果。

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