标题：自制小夹板外固定治疗第一掌骨基底部骨折脱位疗效观察

      作者：黄学雄，刘国防，钟鸣    河源市华信泰康医院骨科，广东 河源 517139

      卷次： 2022年33卷16期

      【摘要】 目的 研究自制小夹板外固定治疗第一掌骨基底部骨折脱位的治疗效果及其临床应用价值。方法 前瞻性选取2020年1月至2021年1月间河源市华信泰康医院骨科收治的80例第一掌骨基底部骨折脱位患者作为研究对象，按随机数表法将患者分为观察组和对照组，每组40例。两组患者均采用手法复位，复位完成后观察组患者采用自制小夹板外固定治疗，对照组患者采用石膏外固定治疗。于手术完成后12周对患者进行随访，采用总主动活动度(TAM)评分系统评价两组患者的治疗效果，并以S?lgeback评价法比较两组患者治疗后的主观感受，同时比较两组患者治疗后的关节屈伸活动度(ROM)和握力，以及术后12周内的并发症发生情况。结果 治疗完成12周后，观察组患者的患侧手部TAM评分优良率为92.50%，明显高于对照组的 75.00%，差异有统计学意义(P<0.05)；两组患者的主观感受比较差异无统计学意义(P>0.05)；治疗12周后，观察组患者的患侧第一腕掌关节屈伸ROM、拇指外展ROM和握力与同组健侧比较差异均无统计学意义(P>0.05)，而对照组患者的患侧第一腕掌关节屈伸ROM、拇指外展ROM和握力明显低于同组健侧，差异均有统计学意义(P<0.05)；治疗 12周后，观察组患者患侧第一腕掌ROM为(46.58±6.14)°，明显高于对照组的(41.57±5.98)°，患侧拇指外展ROM为(48.90±5.22)°，明显高于对照组的(43.63±7.58)°，患侧握力为(32.61±4.29) kg，明显高于对照组的(28.94±5.94) kg，差异均有统计学意义(P<0.05)；观察组患者的总并发症发生率为5.00%，明显低于对照组的20.00%，差异具有统计学意义(P<0.05)。结论 自制小夹板外固定是治疗第一掌骨基底部骨折脱位的有效治疗手段，其具有与传统固定治疗手段相当的临床疗效，同时还能显著改善患者患侧关节的屈伸活动情况，增强手掌握力，且能够一定程度上减少相关并发症的发生。
      【关键词】 第一掌骨基底部骨折脱位；小夹板固定；手法复位；疗效；并发症
      【中图分类号】 R683.41 【文献标识码】 A 【文章编号】 1003—6350（2022）16—2079—04

Effect of self-made small splint external fixation in the treatment of fracture and dislocation of the base of thefirst metacarpal bone.
HUANG Xue-xiong, LIU Guo-fang, ZHONG Ming. Department of Orthopedics, Heyuan HuaxinTaikang Hospital, Heyuan 517139, Guangdong, CHINA
【Abstract】 Objective To study the therapeutic effect and clinical application value of self-made small splintexternal fixation in the treatment of fracture and dislocation of the base of the first metacarpal bone. Methods Eightypatients with fracture and dislocation of the base of the first metacarpal bone who were admitted to Heyuan Huaxin Tai-kang Hospital from January 2020 to January 2021 were prospectively selected as the research objects. The patients weredivided into an observation group and a control group by random number table method, with 40 patients in each group.Manual reduction was applied to both groups of patients. After reduction, patients in the observation group were treatedwith self-made small splint external fixation, and those in the control group were treated with plaster external fixation.The patients were all followed up for 12 weeks after the operation, and the total active mobility (TAM) scoring systemwas used to observe and compare the treatment effects of the two groups. S?lgeback evaluation method was used to com-pare the subjective feelings of the two groups of patients after treatment. At the same time, the joint flexion and exten-sion range of motion (ROM) and grip strength of the two groups of patients after treatment were collected and compared,as well as the complications within 12 weeks after the operation. Results At 12 weeks after treatment, the excellentand good rate of TAM score of the affected hand in the observation group was 92.50%, which was significantly higherthan 75.00% in the control group (P<0.05). There was no significant difference in subjective feelings between the twogroups (P>0.05). At 12 weeks after treatment, the flexion and extension ROM, thumb abduction ROM, and grip strengthof the affected side of the first carpal metacarpal joint in the observation group were not significantly different fromthose in the healthy side in the same group (P>0.05); the flexion and extension ROM, thumb abduction ROM, and gripstrength of the affected side of the first carpal metacarpal joint in the control group were lower than those of thehealthy side in the same group (P<0.05). The ROM of the first carpometacarpal joint in the observation group was(46.58±6.14)°, which was significantly higher than (41.57±5.98)° in the control group; the abduction ROM of the affect-ed thumb was (48.90±5.22)°, which was significantly higher than (43.63±7.58)° of the control group; the grip strengthof the affected side was (32.61±4.29) kg, which was significantly higher than (28.94±5.94) kg of the control group; thedifferences were all statistically significant (P<0.05). The incidence of complications in the observation group was