Liu Anxiong, Sun Haoran, Jiang Zongyuan, Ouyang Yanggang, Chen Qi, Xie Tongming, Liang Hai
Department of Hand Surgery, People's Hospital of Longhua, Shenzhen Guangdong, 518109, P.R.China.
Department of Hand Surgery, People's Hospital of Longhua, Shenzhen Guangdong, 518109,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Aug 15;32(8):984-988. doi: 10.7507/1002-1892.201711006.
To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury.
Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base.
All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%.
Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.
探讨在钩骨-掌骨联合损伤治疗过程中维持第四和第五掌骨基底间稳定性的有效性。
2015年9月至2017年6月，治疗13例钩骨-掌骨联合损伤患者，其中男性12例，女性1例，年龄17至55岁（平均30.8岁）。损伤原因包括10例拳击伤和3例摔伤。单纯第四掌骨基底骨折2例，第四掌骨基底骨折合并掌骨间韧带断裂1例，第四和第五掌骨基底骨折7例，第四掌骨基底骨折合并第五掌骨基底骨折脱位2例，第四和第五掌骨基底骨折合并钩骨骨折1例。受伤至手术时间为5至11天（平均7.2天）。根据第四和第五掌骨基底间不同损伤程度及稳定性变化，对不同程度损伤进行初步分型：Ⅰ型2例，Ⅱ型1例，Ⅲ型7例，Ⅳ型2例，Ⅴ型1例。患者在恢复第四和第五掌骨基底间稳定性原则下采用相应内固定方法治疗。
所有切口均一期愈合，无感染或皮肤坏死。13例患者均获随访，随访时间6至18个月，平均9.4个月。所有骨折临床愈合，愈合时间5.5至8.0周，平均6.3周。未发生钢板断裂、骨折脱位、骨折畸形愈合及骨不连等并发症。术后6个月根据手外科总主动活动度（TAM）功能评价标准对手功能进行评价，结果优9例，良3例，可1例，优良率92.3%。
第四和第五掌骨基底间稳定性对钩骨-掌骨联合损伤的分型及治疗具有重要意义。
