钩掌关节骨折脱位的损伤特点及治疗方法_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 田建 , 芮永军 , 糜菁熠 , 邱扬 , 周建东 , 柯尊山

无锡市手外科医院手外科（江苏无锡，214062）;

Corresponding author：

田建, Email: tianjian828@163.com

Keywords：

钩掌关节; 骨折; 脱位; 内固定

DOI：

10.7507/1002-1892.20140256

Video：

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目的总结钩掌关节骨折脱位的损伤特点和治疗方法。方法 2010年12月－2013年8月收治钩掌关节骨折脱位10例。男9例，女1例；年龄17～51岁，平均28.1岁。致伤原因：拳击伤8例，重物击伤1例，交通事故伤1例。9例新鲜损伤根据Cain等分型标准，ⅠA型1例，ⅠB型1例，Ⅱ型3例，Ⅲ型4例；均行切开复位内固定。1例钩掌关节骨折脱位畸形愈合，伤后2年6个月行钩掌关节融合术。结果术后患者切口均Ⅰ期愈合。10例均获随访，随访时间8～24个月，平均10.4个月。术后无环、小指麻木及手内在肌萎缩，无再骨折或脱位发生。9例新鲜骨折均于术后3个月内获得愈合，钩掌关节均恢复正常解剖关系；末次随访时握力达32.8～42.5 kg，平均36.5 kg；Cooney腕关节评分85～100分，平均92.5分；疼痛视觉模拟评分（VAS）均为0分。另1例钩掌关节融合术后10周植骨融合，术后12个月握力12 kg，Cooney腕关节评分70分，VAS评分0分。结论钩掌关节骨折脱位多为拳击伤，损伤程度与掌骨纵向撞击和屈曲角度有关；正侧位X线片不能很好显露钩掌关节，旋前斜位X线片和CT可评估损伤类型；通过切开复位内固定获得正常解剖关系可取得良好效果。

Citation： 田建, 芮永军, 糜菁熠, 邱扬, 周建东, 柯尊山. 钩掌关节骨折脱位的损伤特点及治疗方法. 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.	赵民, 田德虎, 邵新中, 等.第五掌骨基底部骨折伴腕掌关节脱位的诊断及治疗.中国修复重建外科杂志, 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.

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. 赵民, 田德虎, 邵新中, 等.第五掌骨基底部骨折伴腕掌关节脱位的诊断及治疗.中国修复重建外科杂志, 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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钩掌关节骨折脱位的损伤特点及治疗方法

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