Yang Huanyou, Wang Bin, Li Ruiguo, Zhang Jian
No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Apr 15;34(4):489-492. doi: 10.7507/1002-1892.201908114.
To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.
Five patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.
All the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] ( =0.094, =0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] ( =18.108, =0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.
For the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.
探讨空心螺钉治疗钩骨钩基底骨折的有效性。
2015年6月至2019年2月，对5例钩骨钩基底骨折患者行切开复位空心螺钉内固定治疗，年龄24～47岁，平均31岁。男4例，女1例。致伤原因：运动损伤3例，坠落伤1例，挤压伤1例。其中1例合并手掌尺侧一个半手指感觉障碍。所有患者患侧握力较健侧均明显下降。受伤至手术时间为3～8天，平均4.2天。术后定期随访，测量患指及健指握力、患侧环指及小指总活动度。采用Darrow标准评价疗效。
所有切口均一期愈合。所有患者均获随访，时间6～32个月，平均16个月。X线片示钩骨钩基底骨折达骨性愈合，愈合时间为2.0～3.5个月，平均2.2个月。末次随访时，患侧握力为（35.80±3.76）kg，与健侧[（36.00±4.94）kg]比较差异无统计学意义（t =0.094，P =0.930）；患侧环指及小指总活动度为（529.0±8.9）°，与术前[（232.0±34.7）°]比较差异有统计学意义（t =18.108，P =0.000）。1例尺神经损伤患者，其支配区两点辨别觉为4 mm，痛觉及温度觉恢复正常。按Darrow标准评定，结果优4例，良1例。
对于钩骨钩基底骨折，空心螺钉内固定可获得可靠复位与固定，为骨折断端提供持续加压及抗旋转作用，从而允许早期关节活动，促进骨折愈合及腕关节功能恢复。是治疗钩骨钩基底骨折较为理想的方法。
