本文選題：第一掌骨基底部骨折　切入點：閉合復(fù)位　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景及目的： 手是一個特別復(fù)雜的器官，在人們的日常生產(chǎn)生活中起著重要作用。手部最為重要的第一腕掌關(guān)節(jié)由第一掌骨基底與大多角骨組成，形成特有的鞍狀關(guān)節(jié)，該關(guān)節(jié)在拇指的外展、對掌活動中起著重要的作用。而第一掌骨基底部骨折在手部骨與關(guān)節(jié)損傷中比較常見，且該骨折破壞第一腕掌關(guān)節(jié)，造成不穩(wěn)定型骨折，由于第一腕掌關(guān)節(jié)的特殊解剖結(jié)構(gòu)，骨折臨床分型較多，治療方法多種，療效不一，如果治療不當可導(dǎo)致骨折畸形愈合，晚期導(dǎo)致并發(fā)創(chuàng)傷性關(guān)節(jié)炎，嚴重影響拇指外展、對掌活動，進而影響手部功能，因此選擇一種操作簡單、固定可靠、療效優(yōu)良的方法治療第一掌骨基底部骨折極其重要，也是臨床醫(yī)生積極探求的課題。本文就C型臂下閉合復(fù)位克氏針內(nèi)固定治療第一掌骨基底部骨折的臨床療效進行探討。 資料與方法: 本文研究的病例均采集于吉林大學(xué)中日聯(lián)誼醫(yī)院手外科門診及病房2012年9月～2015年1月符合入選標準的病例，均采用C型臂透視下閉合復(fù)位克氏針內(nèi)固定、石膏托外固定治療的19例第一掌骨基底部骨折病例的臨床資料進行分析。其中男11例，女8例；年齡27～65歲，平均39.5歲。傷后至手術(shù)時間1.5h～3d，平均10.3h。骨折根據(jù)Green分型：Ⅰ型Bennett骨折2例，Ⅲ型成人關(guān)節(jié)外骨折17例。術(shù)后對患者進行隨訪，分別采用：①TAM系統(tǒng)評定法來評價手指主動活動度及骨折愈合情況；②采用S lgeback等方法評定患者主觀感受情況；③應(yīng)用量角器測量第一腕掌關(guān)節(jié)屈伸活動度及拇指屈伸活動度（ROM）及用Jamar測力計測量握力，并與健側(cè)比較。 結(jié)果： 手術(shù)時間15-45min,平均30min；術(shù)后住院時間1-3d。術(shù)后患者均獲隨訪，，隨訪時間6～12周，平均6.5周：19例，患者骨折均獲骨性愈合，愈合時間為4～6周，平均5.5周。依據(jù)TAM系統(tǒng)評定法及患者主觀感受情況14例優(yōu)，4例良，1例中，優(yōu)良率94.7%。其中1例發(fā)生針道感染，2例發(fā)生克氏針略松動。第一腕掌關(guān)節(jié)屈伸活動度及拇指屈伸活動度（ROM）及握力與健側(cè)比較，無明顯差異。 結(jié)論： C型臂下閉合復(fù)位克氏針內(nèi)固定治療第一掌骨基底部骨折具有操作簡單、復(fù)位滿意、固定可靠、骨折愈合時間短，早期實現(xiàn)功能鍛煉，有效降低術(shù)后關(guān)節(jié)疼痛、關(guān)節(jié)活動受限和創(chuàng)傷性關(guān)節(jié)炎的發(fā)生率，臨床療效滿意，適合臨床推廣應(yīng)用。 該術(shù)式具有以下特點：①操作簡便，無手術(shù)切口，對局部皮膚血運無影響,減少術(shù)后感染機會。②不剝離骨膜、不破壞骨折端血運及關(guān)節(jié)囊的完整性，有利于骨折愈合。③降低肌腱粘連、關(guān)節(jié)攣縮機會。④一般術(shù)后3天即可出院,縮短住院日。⑤隨訪及拆除固定物均可在門診完成，避免二次損傷。⑥克氏針價格便宜,減輕了患者的經(jīng)濟負擔和精神負擔。⑦對于伴隨其他疾�。ㄐ呐K病、高血壓、糖尿病等）的患者,大大減少了手術(shù)風(fēng)險。
[Abstract]:Background and objectives:. The hand is a particularly complex organ that plays an important role in people's daily life. The most important first carpometacarpal joint of the hand consists of the base of the first metacarpal bone and most of the horn bones, forming a unique saddle joint. The joint plays an important role in the metacarpal movement, and the fracture of the base of the first metacarpal bone is more common in the injuries of the hand bone and joint, and the fracture destroys the first metacarpal joint and causes unstable fracture. Because of the special anatomical structure of the first carpometacarpal joint, the fracture has many clinical types, many treatment methods and different curative effects. If the treatment is improper, it can lead to the fracture malunion, the late stage leads to traumatic arthritis, which seriously affects the abduction of the thumb. Therefore, it is very important to choose a simple, reliable and effective method to treat the fracture of the base of the first metacarpal bone. This paper discusses the clinical effect of closed reduction with Kirschner needle in the treatment of the first metacarpal base fracture. Information and methods:. All the cases were collected from hand surgery outpatient department and ward of Sino-Japanese Friendship Hospital of Jilin University from September 2012 to January 2015. All the patients were treated with closed reduction and Kirschner needle internal fixation under C-arm fluoroscopy. The clinical data of 19 cases of first metacarpal base fracture treated by plaster external fixation were analyzed. The average age was 39.5 years. The average time from injury to operation was 1.5 hours to 3 days, with an average of 10.3 hours. According to Green classification, there were 2 cases of type 鈪

本文編號：1560461