Ebraheim C型钩骨体冠状面骨折的诊断和治疗

摘要

Objective To evaluate the treatment effects of Ebraheim C coronal fracture of the hamate with fixation of titanium miniplate crossing carpometacarpal joint. Methods From December 2011 to November 2015, 12 patients suffered from Ebraheim C coronal fracture of the hamate were treated with fixation of titanium miniplate crossing carpometacarpal joint. All the hamate fractures were exposed by dorsal approach. After the reduction, the fractures were fixed with titanium miniplate crossing carpometacarpal joint dorsally. The Disabilities of the Arm, Shoulder and Hand (DASH), visual analogue scale (VAS), MAYO Wrist Score, grip strength and ring and small fingers total active motion (TAM) were employed to evaluate the functions. All patients took X rays during follow-up. Results All 12 patients were followed up from 9 to 42 months, average (18±9) months. Hamate fractures healed from 6 to 10 weeks, average (7.4±1.5) weeks. Except three cases, all titanium miniplates and screws were removed at 3 to 4 months post-operatively. At final follow-up, DASH scores were from 0 to 10.8, with an average 2.4 ±4.4. MAYO Wrist Scores were from 65 to 100, with an average 93.8 ± 11.9. Grip strength averaged (42.6±5.1) kg on the injured side and averaged (42.0±3.5) kg on the contralateral side. TAM of the ring and small fingers were 280° ±5° and 270° ±5° on the injured side, meanwhile 283° ±3° and 272°±4° on the contralateral side. Grip strength and TAM of both sides showed no statistical significance. Conclusion Ebraheim C coronal fracture of hamate could be fixed with titanium miniplate crossing carpometacarpal joint. The procedure could provide stability and allow early motion, which could help to maintain joint reduction and obtain reliable fracture healing and good hand function. This technique may be an optional choice in clinical practice.%目的 探讨Ebraheim C型钩骨体冠状面骨折的诊断要点和手术疗效.方法 2011年12月-2015年11月,采用微型钛板经腕掌关节固定治疗Ebraheim C型钩骨体冠状面骨折12例.术中均采用腕掌关节背侧入路显露骨折与脱位,复位后微型钛板经腕掌关节放置于掌骨干和钩骨体的背侧以固定钩骨体骨折与腕掌关节脱位.采用臂肩手功能障碍评估表(The Disabilities of the Arm,Shoulder and Hand,DASH)、疼痛视觉模拟评分(visual analogue scale,VAS)、Mayo腕关节评分、患侧和健侧手部握力,及环、小指总的主动活动度(total active motion,TAM)评价患者术后功能,同时定期拍摄腕关节X线片.结果 12例患者均获得随访,随访时间9~42个月,平均(18±9)个月;钩骨骨折均完全愈合,愈合时间6~10周,平均(7.4±1.5)周.除3例外,所有患者均于术后3~4个月取出内固定物.末次随访时,DASH评分0~10.8分,平均(2.4±4.4)分;VAS评分0~3分,平均(0.58±1.1)分;Mayo腕关节评分65~100分,平均(93.8±1.9)分.末次随访时,手部握力患侧(42.6±5.1)kg,健侧(42.0±3.5)kg;环指与小指总的活动度患侧分别为280°±5°和270°±5°,健侧分别为283°±3°和272°±4°,握力和活动度患侧与健侧比较均无统计学差异.结论 微型钛板经腕掌关节固定Ebraheim C型钩骨体冠状面骨折牢固,有助于维持关节复位,术后骨折愈合及手部功能良好,是治疗该型钩骨体冠状面骨折的有效手术方法.