目的 探讨微创内固定结合外固定治疗第一掌骨基底部关节内骨折的疗效.方法 自2014年9月至2016年4月共收治第一掌骨基底部关节内骨折患者11例.所有骨折均先在微创操作下克氏针初步固定,能闭合复位则避免切开,需切开复位的则以小切口辅助下行骨折复位内固定.结合外固定支架牵张固定,将第一腕掌关节撑开2～3 mm,辅以石膏托固定.结果 所有患者骨折于7～9周愈合,愈合时间平均7.6周.术后5～6周拆除外固定支架,行功能锻炼.术后随访时间为4～18个月,平均10.5个月,根据中华医学会手外科学会上肢部分功能评定试用标准对拇指进行功能评价:优8例,良2例,可1例.结论 第一掌骨基底部关节内骨折,尤其是粉碎性骨折的治疗,使用外固定支架辅以克氏针内固定,将腕掌关节撑开,术后疗效满意.%Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with extemal fixator for treatment of intra-articular fracture of the first metacarpal base.Methods From September 2014 to April 2016,eleven patients with intra-articular fractures of the base of the first metacarpal were treated.All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction.Small incision was made for these that could not be fixed with closed reduction.Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction.The forearm was immobilized with a plaster cast.Results The time of fracture healing was 7 to 9 weeks,the average being 7.6 weeks.The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed.Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months.Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up,which revealed excellent results in 8 cases,good in 2 cases,and fair in 1 case.Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal,application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results.
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