弹性髓内钉对掌骨骨折的外科治疗

背景与目的：大多数的掌骨骨折可以采取保守治疗的方法。手术适合于一些特定的病例如：在骨折侧位片上成角大于30度、短缩超过5mm或者有旋转移位。本文的目的是分析应用预弯1.6mm克氏针治疗关节外掌骨骨折的临床效果。方法：先将克氏针弯曲成尖部弯曲大约在5mm左右,较长的轴部向着与尖部相反的方向弯曲的稳定S型。首先用2.5mm的钻头钻入掌骨基底部,然后用克氏针的尾部顺行插入,当克氏针经过骨折部位时复位骨折。应用克氏针三点固定的原理固定骨折,用手指夹板固定,早期进行掌指关节的活动。结果：自2009年到2010年我们探索性的固定了5例第五掌骨和2例第一掌骨。病人的平均年龄是35岁,其中6例男性、1例女性。外科治疗的平均时间是13天（4天至28天）,骨折全部愈合良好。克氏针拔出的平均时间是4.5周（3至6周）。结论：单根预弯克氏针治疗掌骨骨折,不仅简单、快捷而且可以早期行患手各关节功能练习,使手部关节功能获得满意恢复,是掌骨骨折治疗过程中的一种理想方法

The Surgical Treatment of Elastic Intramedullary Nailing on Metacarpal Fractures

Background and Objective： The majority of metacarpal fractures can be treated conservatively.Nevertheless,surgical treatment is justified in certain cases which angulation at the fracture site in a true lateral radiograph of at least 30 degrees,shortening of 5 mm and/or in the presence of a rotatory deformity.The aim of our study was to evaluate the clinical results of using a pre-bent 1.6mm Kirschner wire（K-wire） for extra-articular metacarpal fractures.Methods： The single K-wire is pre-bent in a lazy-S fashion that the sharp was bend at approximately 5 mm and the longer smooth curve was bent to the opposite direction.The fist using a 2.5 mm drill made an initial entry point at the metacarpal,then the K-wire was inserted blunt end in an antegrade manner and the fracture reducedwhen the wire was passed across the fracture site.The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic.Results： We reviewed used single K-wire as internal fixation of 5 little finger and 2 ring finger metacarpal fractures from November 2009 to August 2010.The average age of the cohort was 35 years with 1 women and 6 men.The time to surgical intervention was a mean 13 days（range 4 to 28 days）.All fractures proceeded to bony union.The pre-bent single K-wire was allow early unimpeded movement in wrist and hand together which extracted at an average of 4.5 weeks.Conclusions： With this simple and minimally invasive technique per-formed as day-case surgery,all patients were able to start mobilisation.early as soon as possible.The general outcome was good hand function with few complications.