Objective: To analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.
Methods: The clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.
Results: The operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value ( t=-20.02, P=0.00); and there was no significant difference ( t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference ( t=-1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.
Conclusion: The effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
目的: 分析在高频超声引导下弹性髓内钉固定治疗第 5 掌骨颈骨折的可行性和疗效。.
方法: 回顾分析 2013 年 5 月—2017 年 9 月在高频超声引导下利用弹性髓内钉治疗的 30 例第 5 掌骨颈骨折患者临床资料。其中男 24 例，女 6 例；年龄 18～58 岁，平均 31.4 岁。第 5 掌骨头干角（55.6±11.3）°。受伤至手术时间 12 h～8 d，平均 2.4 d。记录手术时间、术中透视次数、骨折复位、并发症发生情况及骨折愈合时间；骨折愈合后测量患侧第 5 掌骨头干角并与健侧比较；末次随访时测量健患侧第 5 掌指关节主动活动度，采用中华医学会手外科学会手指功能活动度（TAM）评价标准评价功能。.
结果: 手术时间 22～40 min，平均 32.4 min；术中均透视 1 次；超声图像及 X 线透视显示骨折复位良好，无需再次调整。术后切口均愈合良好，无肌腱粘连、局部麻木情况发生。30 例患者均获随访，随访时间 8～16 个月，平均 11.7 个月。骨折愈合时间为 4～8 周，平均 5.6 周。患侧第 5 掌骨头干角为（13.2±1.4）°，较术前显著改善（ t=−20.02， P=0.00）；与健侧（12.6±1.0）° 比较差异无统计学意义（ t=1.94， P=0.06）。末次随访时，患侧第 5 掌指关节主动活动度为（89.4±2.4）°，与健侧（90.3±2.0）° 比较差异无统计学意义（ t=−1.58， P=0.13）；根据中华医学会手外科学会 TAM 评价标准，所有患指均为优。.
结论: 高频超声引导下弹性髓内钉固定治疗第 5 掌骨颈骨折疗效确切，术中能从不同角度动态观察骨折复位情况，减少电离辐射和术后并发症。.
Keywords: High frequency ultrasound; intramedullary nail; minimally invasive surgery; the fifth metacarpal neck fracture.