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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第34卷

期数:

2022年01期

页码:

41-46

栏目:

临床研究

出版日期:

2022-01-20

文章信息/Info

Title:

A comparative study of closed reduction and full-thread hollow compression screws internal fixation versus open reduction and plate-screws internal fixation for treatment of Bennett fractures

作者:

林勇¹; 罗伟斌¹; 叶前驱¹; 曾广辉¹; 阮张涛¹; 曾秋涛¹; 周驰²

(1.广东医科大学附属第三医院/佛山市顺德区龙江医院,广东 佛山 528318; 2.广州中医药大学第一附属医院,广东 广州 510405)

Author(s):

LIN Yong¹; LUO Weibin¹; YE Qianqu¹; ZENG Guanghui¹; RUAN Zhangtao¹; ZENG Qiutao¹; ZHOU Chi²

1.The Third Affiliated Hospital of Guangdong Medical University(Shunde Longjiang Hospital),Foshan 528318,Guangdong,China;2.The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China

关键词:

掌骨;  腕掌关节;  骨折脱位;  骨折固定术; 内;  骨螺丝;  Bennett骨折;  临床试验

Keywords:

metacarpal bones;  carpometacarpal joints;  fracture dislocation;  fracture fixation; internal;  bone screws;  Bennett fractures;  clinical trial

摘要:

目的:比较闭合复位全螺纹空心加压螺钉内固定与切开复位钢板螺钉内固定治疗Bennett骨折的临床疗效及安全性。方法:回顾性分析2015年1月至2020年1月收治的43例Bennett骨折患者的病例资料,采用闭合复位全螺纹空心加压螺钉内固定治疗者20例(空心加压螺钉组),采用切开复位钢板螺钉内固定治疗者23例(钢板螺钉组)。比较两组患者的手术时间、术中出血量、骨折愈合时间、采用拇指功能评价标准评价的患侧拇指功能、采用Hotchkiss骨折与关节移位标准评价的第一腕掌关节面恢复情况、采用上肢功能障碍(disabilities of the arm,shoulder and hand,DASH)评分标准评价的综合疗效以及并发症发生情况。结果:①一般指标。2组患者手术时间、术中出血量及骨折愈合时间比较,组间差异均无统计学意义[(39.30±5.63)min,(38.87±5.00)min,t=0.266,P=0.792;(30.85±4.71)mL,(29.91±5.49)mL,t=0.596,P=0.554;(6.95±1.43)周,(7.04±1.36)周,t=-0.219,P=0.828]。②拇指功能。术后6个月,空心加压螺钉组的拇指功能优16例、良3例、差1例,钢板螺钉组的拇指功能优11例、良9例、差3例,空心加压螺钉组的拇指功能优于钢板螺钉组(Z=-2.108,P=0.035)。③第一腕掌关节面恢复情况。术后12个月,空心加压螺钉组的第一腕掌关节面恢复情况优17例、良2例、差1例,钢板螺钉组的第一腕掌关节面恢复情况优12例、良9例、差2例,空心加压螺钉组的第一腕掌关节面恢复情况优于钢板螺钉组(Z=-2.161,P=0.031)。④DASH评分。时间因素与分组因素不存在交互效应(F=2.198,P=0.118)。2组患者DASH评分总体比较,组间差异无统计学意义,即不存在分组效应(F=-1.607,P=0.110)。手术前后不同时间点DASH评分的差异有统计学意义,即存在时间效应(F=14.001,P=0.001)。2组DASH评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致。术前2组患者DASH评分比较,差异无统计学意义[(71.45±6.00)分,(72.52±6.95)分,t=-0.537,P=0.594]。术后3个月、6个月,空心加压螺钉组的DASH评分均低于钢板螺钉组[(56.95±5.94)分,(60.70±5.09)分,t=-2.228,P=0.031;(39.05±5.54)分,(45.78±6.82)分,t=-3.520,P=0.001]。⑤安全性评价结果。空心加压螺钉组出现1例骨折畸形愈合、1例第一腕掌关节创伤性关节炎,钢板螺钉组出现1例切口感染、2例骨折畸形愈合、1例第一腕掌关节创伤性关节炎、1例第一腕掌关节半脱位。2组患者并发症发生率比较,差异无统计学意义(χ2=1.082,P=0.298)。结论:闭合复位全螺纹空心加压螺钉内固定与切开复位钢板螺钉内固定治疗Bennett骨折,两者在手术时间、术中出血量、骨折愈合时间及并发症发生率方面无明显差异,但前者的拇指功能、第一腕掌关节面恢复情况及综合疗效更好。

Abstract:

Objective:To compare the clinical curative effects and safety of closed reduction and full-thread hollow compression screws(HCSs)internal fixation versus open reduction and plate-screws(PSs)internal fixation in treatment of Bennett fractures.Methods:The medical records of 43 patients with Bennett fractures recruited from January 2015 to January 2020 were analyzed retrospectively.Twenty patients were treated with closed reduction and full-thread HCSs internal fixation(HCSs group)and 23 ones with open reduction and PSs internal fixation(PSs group).The operative time,intraoperative blood loss,fracture healing time,function of the injuried thumb evaluated by using thumb function evaluation criteria,recovery of the first carpometacarpal(CMC-1)joint surface assessed by using Hotchkiss fracture and joint displacement criteria,the total clinical curative effects evaluated by using disabilities of the arm,shoulder and hand(DASH)scoring criterion and postoperative complication incidence were compared between the 2 groups.Results:①There was no statistical difference in operative time,intraoperative blood loss and fracture healing time between the 2 groups(39.30±5.63 vs 38.87±5.00 minutes,t=0.266,P=0.792; 30.85±4.71 vs 29.91±5.49 mL,t=0.596,P=0.554; 6.95±1.43 vs 7.04±1.36 weeks,t=-0.219,P=0.828).②The function of the injuried thumbs was evaluated at 6 months after the surgery,and 16 patients obtained an excellent result,3 good and 1 poor in HCSs group; while 11 ones obtained an excellent result,9 good and 3 poor in PSs group.The thumb function was better in HCSs group compared to PSs group(Z=-2.108,P=0.035).③The recovery of the CMC-1 joint surfaces was assessed at 12 months after the surgery,and 17 patients obtained an excellent result,2 good and 1 poor in HCSs group; while 12 ones obtained an excellent result,9 good and 2 poor in PSs group.The recovery of the CMC-1 joint surfaces was better in HCSs group compared to PSs group(Z=-2.161,P=0.031).④There was no interaction between time factor and group factor in DASH scores(F=2.198,P=0.118).There was no statistical difference in DASH scores between the 2 groups in general,in other words,there was no group effect(F=-1.607,P=0.110).There was statistical difference in DASH scores between different timepoints before and after the surgery,in other words,there was time effect(F=14.001,P=0.001).The DASH scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in DASH scores between the 2 groups before the surgery(71.45±6.00 vs 72.52±6.95 points,t=-0.537,P=0.594).The DASH scores were lower in HCSs group compared to PSs group at 3 and 6 months after the surgery(56.95±5.94 vs 60.70±5.09 points,t=-2.228,P=0.031; 39.05±5.54 vs 45.78±6.82 points,t=-3.520,P=0.001).⑤After the surgery,the fracture malunion(1 case)and the CMC-1 joint traumatic osteoarthritis(1 case)were found in HCSs group; whereas the incision infection(1 case),fracture malunion(2 cases),the CMC-1 joint traumatic osteoarthritis(1 case)and the CMC-1 joint subluxation(1 case)were found in PSs group.There was no statistical difference in complication incidences between the 2 groups(χ2=1.082,P=0.298).Conclusion:There is no obvious difference in operative time,intraoperative blood loss,fracture healing time and complication incidence between the therapy of closed reduction and full-thread HCSs internal fixation and the therapy of open reduction and PSs internal fixation in treatment of Bennett fractures,while the former surpasses the latter in thumb function outcome,the CMC-1 joint surface recovery and total clinical curative effects.