Ceccarelli Romain, Dumontier Christian, Camuzard Olivier
Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hopital Pasteur 2, Nice.
Centre de la Main, Urgences Main, Clinique les Eaux Claires, Baie-Mahault, Guadeloupe, France.
J Hand Surg Am. 2019 Nov;44(11):993.e1-993.e6. doi: 10.1016/j.jhsa.2019.01.014. Epub 2019 Feb 21.
Optimal treatment of acute hook of hamate fractures (HHF) remains controversial. Isolated acute HHF can be treated nonsurgically or surgically (with excision of the hook or open reduction internal fixation). The authors present the functional outcomes of a case series of patients who were treated with minimally invasive volar fixation for acute HHF.
This retrospective study reviewed 6 patients with nondisplaced acute HHF treated with a minimally invasive volar approach and cannulated mini-screw fixation. The development of postoperative complications (tendon and ulnar nerve lesions), pain evaluated using a visual analog scale, and radiological union evaluated on computed tomography scan is reported. Wrist range of motion and grip strength were measured bilaterally. Mayo Wrist Score and Quick-Disabilities of the Arm, Shoulder, and Hand were assessed. All outcomes were measured at 1, 2, 3, and 6 months after surgery.
Fixation of HHF through the volar approach was achieved in all cases with no complications. The clinical and radiological union rate was 100%. All patients were able to return to their work or hobbies after an average of 7 weeks.
This study suggests that acute HHF can be treated successfully by open reduction internal fixation using a volar approach with minimal morbidity and complications, a good union rate, and a fast return to daily activities.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
急性钩骨钩骨折（HHF）的最佳治疗方法仍存在争议。孤立性急性HHF可采用非手术或手术治疗（切除钩骨钩或切开复位内固定）。作者介绍了一系列采用微创掌侧固定治疗急性HHF患者的功能预后情况。
本回顾性研究纳入了6例采用微创掌侧入路和空心微型螺钉固定治疗的无移位急性HHF患者。报告了术后并发症（肌腱和尺神经损伤）的发生情况、采用视觉模拟量表评估的疼痛情况以及通过计算机断层扫描评估的影像学愈合情况。双侧测量腕关节活动范围和握力。评估Mayo腕关节评分以及手臂、肩部和手部快速残疾评定量表。所有预后指标均在术后1、2、3和6个月进行测量。
所有病例均通过掌侧入路成功固定HHF，无并发症发生。临床和影像学愈合率为100%。所有患者平均在7周后能够恢复工作或继续从事爱好活动。
本研究表明，急性HHF采用掌侧入路切开复位内固定治疗可取得成功，具有发病率和并发症低、愈合率高以及能快速恢复日常活动的特点。
研究类型/证据水平：治疗性研究V级
