鉤掌關節骨折脫位的損傷特點及治療方法_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 田建 , 芮永軍 , 糜菁熠 , 邱揚 , 周建東 , 柯尊山

無錫市手外科醫院手外科（江蘇無錫，214062）;

Corresponding?author：

田建, Email: tianjian828@163.com

Keywords：

鉤掌關節; 骨折; 脫位; 內固定

DOI：

10.7507/1002-1892.20140256

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目的總結鉤掌關節骨折脫位的損傷特點和治療方法。方法 2010年12月－2013年8月收治鉤掌關節骨折脫位10例。男9例，女1例；年齡17～51歲，平均28.1歲。致傷原因：拳擊傷8例，重物擊傷1例，交通事故傷1例。9例新鮮損傷根據Cain等分型標準，ⅠA型1例，ⅠB型1例，Ⅱ型3例，Ⅲ型4例；均行切開復位內固定。1例鉤掌關節骨折脫位畸形愈合，傷后2年6個月行鉤掌關節融合術。結果術后患者切口均Ⅰ期愈合。10例均獲隨訪，隨訪時間8～24個月，平均10.4個月。術后無環、小指麻木及手內在肌萎縮，無再骨折或脫位發生。9例新鮮骨折均于術后3個月內獲得愈合，鉤掌關節均恢復正常解剖關系；末次隨訪時握力達32.8～42.5 kg，平均36.5 kg；Cooney腕關節評分85～100分，平均92.5分；疼痛視覺模擬評分（VAS）均為0分。另1例鉤掌關節融合術后10周植骨融合，術后12個月握力12 kg，Cooney腕關節評分70分，VAS評分0分。結論鉤掌關節骨折脫位多為拳擊傷，損傷程度與掌骨縱向撞擊和屈曲角度有關；正側位X線片不能很好顯露鉤掌關節，旋前斜位X線片和CT可評估損傷類型；通過切開復位內固定獲得正常解剖關系可取得良好效果。

Citation： 田建, 芮永軍, 糜菁熠, 邱揚, 周建東, 柯尊山. 鉤掌關節骨折脫位的損傷特點及治療方法. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1186-1187. doi: 10.7507/1002-1892.20140256 Copy

1.	Cain JE Jr, Shepler TR, Wilson MR.Hamatometacarpal fracture-dislocation:classification and treatment.J Hand Surg (Am), 1987, 12(5 Pt 1):762-767.
2.	Cooney WP, Bussey R, Dobyns JH, et al.Difficult wrist fractures.Perilunate fracture-dislocations of the wrist.Clin Orthop Relat Res, 1987, (214):136-147.
3.	Schortinghuis J, Klasen HJ.Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations.J Trauma, 1997, 42(6):1052-1055.
4.	Bora FW Jr, Didizian NH.The treatment of injuries to the carpometacarpal joint of the little finger.J Bone Joint Surg (Am), 1974, 56(7):1459-1463.
5.	趙民, 田德虎, 邵新中, 等.第五掌骨基底部骨折伴腕掌關節脫位的診斷及治療.中國修復重建外科雜志, 2013, 27(6):662-665.
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1. Cain JE Jr, Shepler TR, Wilson MR.Hamatometacarpal fracture-dislocation:classification and treatment.J Hand Surg (Am), 1987, 12(5 Pt 1):762-767.
2. Cooney WP, Bussey R, Dobyns JH, et al.Difficult wrist fractures.Perilunate fracture-dislocations of the wrist.Clin Orthop Relat Res, 1987, (214):136-147.
3. Schortinghuis J, Klasen HJ.Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations.J Trauma, 1997, 42(6):1052-1055.
4. Bora FW Jr, Didizian NH.The treatment of injuries to the carpometacarpal joint of the little finger.J Bone Joint Surg (Am), 1974, 56(7):1459-1463.
5. 趙民, 田德虎, 邵新中, 等.第五掌骨基底部骨折伴腕掌關節脫位的診斷及治療.中國修復重建外科雜志, 2013, 27(6):662-665.
6. Mozaffarian K, Vosoughi AR, Hedjazi A, et al.The safest direction of percutaneous pinning for achieving firm fixing of the fifth carpometacarpal joint.J Orthop Sci, 2012, 17(6):757-762.

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鉤掌關節骨折脫位的損傷特點及治療方法

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