非拇指掌关节骨折脱位的手术治疗

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2025-03-01 Epub Date: 2024-12-07 DOI:10.1016/j.jhsg.2024.11.003

Thomas J. Berault MD , Emilio A. Ihde BS , George C. Balazs MD , Aaron A. Olsen DO , Andrew D. Henebry MD

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引用次数: 0

摘要

目的探讨年轻运动人群中除拇指外的腕掌骨（CMC）骨折脱位手术治疗的功能结局和并发症。方法回顾性分析在同一医院接受手术治疗的CMC关节损伤患者6年的资料。如果患者有第一次CMC关节损伤，年龄在18岁以下，或有不完整的文件，则排除患者。损伤x线片分为单纯/关节外片、部分关节片和完全关节片。检索电子健康记录，包括人口统计信息、机制、相关损伤、手术时间、愈合时间、恢复完全活动时间、并发症和需要翻修手术。在最后随访时收集QuickDASH（手臂、肩膀和手的残疾）和患者报告的手腕评估评分。结果共纳入160例患者，其中89%为男性。拳打脚踢是最常见的伤害机制。合并的第四、第五CMC骨折脱位和孤立的第五CMC骨折脱位占所见损伤类型的90%。合并第四和第五CMC关节损伤合并远端腕排骨折的比例为54%。并发症发生率为29%。与k针相关的并发症占总并发症的55%。160例患者中有45例（28%）获得最终随访。最终QuickDASH评分中位数为11.4（范围0-45.5），65%的患者达到患者可接受的症状状态。患者报告的腕部评估评分中位数为18.5分（范围0-67.5），76%符合患者可接受的症状状态。在纳入的133名现役军人患者中，79/133（59%）在术后中位数3.3年仍在现役。结论尽管CMC骨折脱位的手术并发症发生率较高，但手术治疗可获得良好至优异的功能预后。研究类型/证据水平鉴别诊断/系统患病率研究III。

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Operative Treatment of Non-Thumb Carpometacarpal Joint Fracture Dislocations

Purpose

To investigate the functional outcomes and complications of operatively managed carpometacarpal (CMC) fracture dislocations, excluding the thumb, in a young, active population.

Methods

A retrospective chart review of all patients undergoing surgical treatment for CMC joint injuries at a single institution over a 6-year period was performed. Patients were excluded if they had a first CMC joint injury, were under 18 years old, or had incomplete documentation. Injury radiographs were categorized as simple/extra-articular, partial articular, and complete articular. Electronic health records were searched for demographic information, mechanism, associated injuries, time to surgery, time to union, time to return to full-activity, complications, and need for revision surgery. QuickDASH (Disabilities of Arm, Shoulder, and Hand) and Patient-Reported Wrist Evaluation scores were collected at final follow-up.

Results

A total of 160 patients were included in the study, of which 89% were male. Punching was the most common mechanism of injury. Combined fourth and fifth CMC fracture dislocations and isolated fifth CMC fracture dislocations encompassed 90% of the injury patterns seen. Combined fourth and fifth CMC joint injuries had an associated distal carpal row fracture 54% of the time. There was a 29% complication rate. Complications related to K-wires made up 55% of the total complications. Final follow-up was obtained on 45/160 patients (28%). The median final QuickDASH score was 11.4 (range, 0–45.5), with 65% of patients meeting the patient acceptable symptomatic state. Median Patient-Reported Wrist Evaluation score of 18.5 (range, 0–67.5) with 76% meeting the patient acceptable symptomatic state. Among the 133 active-duty military patients included, 79/133 (59%) remained on active-duty at a median of 3.3 years after surgery.

Conclusions

Despite relatively high surgical complication rates, operative management of CMC fracture dislocations results in good-to-excellent functional outcomes.