手术-第1掌骨基底(关节外)骨折切开复位内固定术.docx

1、概述 ? ??? ? ??? ? ? ? Extraarticular fractures of the base of the thumb metacarpal are often displaced, with a flexion deformity and may show palmar comminution (Winterstein fracture).? ? ? ? ? ?第1掌骨基底关节外骨折通常移位明显，呈屈曲畸形，可伴有掌侧粉碎。2、移位机制?? Displacement due to muscle forcesThe pull of the thenar muscles results in palmar flexion of the distal fragment.?骨折远端由于鱼际肌牵拉向掌侧屈曲，背侧成角3、屈曲畸形?? Flexion deformity? ? ? ? ?If the flexion deformity exceeds 30 degrees, thumb function may be impaired due to muscle imbalance. Internal fixation allows for anatomical reduction.? ? ? ? ?如果屈曲畸形超过30°，由于肌肉不平衡，将会影响拇指的功能，建议手术治疗，解剖复位。?4、掌侧粉碎导致不稳定?? Instability due to palmar comminution? ? ? ? ? If standard plates are used, bone graft from the distal radius may be necessary to avoid delay in bone healing and consequent secondary displacement, or failure of fixation. Angularly stable plate fixation, using a locking compression plate (LCP), prevents secondary displacement without the need of bone grafting.?? ? ? ? ??如果使用标准接骨板，建议从桡骨远端取骨进行移植修复以避免骨延迟愈合、骨折二次移位、内固定断裂。而角钢板、LCP钢板则可以不用行骨移植。5、使用钢板间接复位?? Indirect reduction with the plateAngularly stable plate fixation in the proximal fragment allows for reduction using the plate as a lever (as described below).???? ? 使用锁定板可以作为一个杠杆来复位骨折端。6、牵引复位?? Reduction by tractionAlternatively, and especially when a conventional plate is used, reduction can be performed with axial traction on the thumb, either manually, or with help of a finger trap, and simultaneous pressure on the dorsal aspect of the diaphysis.?? ? ??? 当使用普通钢板是，可通过纵向牵引来复位骨折端，同时在掌骨干背外侧给予压力。7、临时固定?? Preliminary stabilizationPreliminary stabilization can be achieved with an obliquely inserted K-wire.If anatomical reduction is demonstrated using image intensification, a 2 mm LCP T-plate is fixed to the dorsal aspect of the first metacarpal using standard locking techniques.?? ? ? ?可以用克氏针完成临时固定，如果经透视复位满意，可以在掌骨背侧放置2mmLCP接骨板使用标准锁定技术。8、钢板长度?? Plate lengthCut the 2.0 mm LCP to length so that 2 screws can be fixed