Rolando骨折的治疗进展
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摘要
<正>1910年,意大利外科医师Rolando首次描述了第1掌骨基底部的"Y"型关节内骨折模式[1]。虽然"Y"或"T"型骨折是经典的模式,但目前"Rolando骨折"一词包括了第1掌骨基底部所有涉及关节面的粉碎性骨折[2-4]。Rolando骨折需要与Bennett骨折进行区分,后者是指第1掌骨基底部关节面两部分骨折,小的骨折块位于掌尺侧并通过韧带与大多角骨相连,大的骨折块因韧带的牵拉而发生桡背侧脱位。
Rolando's Fracture( the first metacarpal bone base comminuted fracture) is a kind of Y type or T type first metacarpal fracture. It's not common clinically and difficult to be treated. Improper handling can lead to nonunion fracture or legacy dysfunction as these fractures and vertical joints in polygonal fractures have the probability of post-traumatic arthritis. Plaster casts have been eliminated at present. For closed reduction under fluoroscopy for the first carpal metacarpal joint fracture and dislocation, Pickett's wire or external static/dynamic fixator( with or without kirschner wire) is used when the alignment is satisfactory, open reduction and internal fixation must be considered while not. Mini T-plate is used with additional tension screw or Kirschner wire when large fragments exist. Kirschner wire is used with additional external fixator when small fragments exist. Therefore, individualized surgical treatment is needed in the treatment of Rolando's fracture.
Rolando's Fracture( the first metacarpal bone base comminuted fracture) is a kind of Y type or T type first metacarpal fracture. It's not common clinically and difficult to be treated. Improper handling can lead to nonunion fracture or legacy dysfunction as these fractures and vertical joints in polygonal fractures have the probability of post-traumatic arthritis. Plaster casts have been eliminated at present. For closed reduction under fluoroscopy for the first carpal metacarpal joint fracture and dislocation, Pickett's wire or external static/dynamic fixator( with or without kirschner wire) is used when the alignment is satisfactory, open reduction and internal fixation must be considered while not. Mini T-plate is used with additional tension screw or Kirschner wire when large fragments exist. Kirschner wire is used with additional external fixator when small fragments exist. Therefore, individualized surgical treatment is needed in the treatment of Rolando's fracture.
引文
[1]Rolando S.Fracture de la base du premier metacarpien et principalment sur une variete non encore decrite[J].La Presse Medicale,1910,33:303-304.
[2]Leibovic SJ.Treatment of bennett’s and rolando’s fractures[J].Tech Hand Upper Extrem Surg,1998,2(B):36-46.
[3]Proubasta IR.Rolando’s fracture of the firstmetacarpal:Treatment by external fixation[J].J Bone Joint Surg,1992,74(A):416-417.
[4]Langhoff O,Andersen K,Kjaer-Petersen K.Rolando’s fracture[J].J Hand Surg,1991,16(B):454-459.
[5]Cooney WP III,Lucca MJ,Chao EY,et al.The kinesiology of the thumb trapeziometacarpal joint[J].J Bone Joint Surg,1981,63(A):1371-1381.
[6]Bettinger PC,Linscheid RL,Berger RA,et al.An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint[J].J Hand Surg,1999,24(A):786-798.
[7]Ollie JE.Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb[J].Hand Clin,2006,22:365-392.
[8]Connell DA,Pike J,Koulouris G,et al.MR imaging of thumb carpometacarpal joint ligament injuries[J].J Hand Surg,2004,29(B):46-64.
[9]Cooney WP III,Chao EY.Biomechanial analysis of static forces in the thumb during hand function[J].J Bone Joint Surg,1977,59(A):27-36.
[10]刘松,陈伟,朱燕宾,等.2010年至2011年中国东部和西部地区第一掌骨基底骨折的流行病学对比分析[J].中华创伤骨科杂志,2017,19(12):1069-1073.
[11]Carlsen BT,Moran SL.Thumb trauma:Bennett fractures,Rolando fractures,and ulnar collateral ligament injuries[J].J Hand Surg,2009,34(A):945-952.
[12]Surzur P,Rigault M,Charissoux JL,et al.Recent fracture of the base of the first metacarpal base:a study of a series of138 cases[In French][J].Ann Chir Main Memb Super,1994,13:122-134.
[13]Liverneaux PA,Ichihara S,Hendriks S,et al.Fractures and dislocation of the base of the thumb metacarpal[J].J Hand Surg Eur Vol,2015,40(1):42-50.
[14]Taichi S,Kevin CC,Steven CH.Operative techniques[J].Hand Wrist Surg(Third Edition),2018:147-154.
[15]Mahoney M,Marsland D,Garagnani L.Rolando and his fracture[J].Trauma,2015,17(1):24-28.
[16]Wiggins HE,Bundens WD.A method of treatment of fracturedislocations of the first metacarpal bone[J].J Bone Joint Surg,1954,36(A):810-819.
[17]刘印文,卫晓恩,高宁阳,等.手法闭合复位经皮穿针内固定治疗第1掌骨基底骨折[J].中医正骨,2014,26(3):54-55.
[18]班照楠,黄富国,顾琪珊,等.闭合复位第一、二掌骨间克氏针固定治疗第一掌骨基底部骨折[J].中华手外科杂志,2015,31(5):351-352.
[19]冯炜,李俊杰,俞立新.闭合复位平行克氏针固定治疗第1掌骨基底部骨折[J].浙江临床医学,2017,19(2):266-267.
[20]Gelberman RH,Vance RM,Zakaib GS.Fractures at the base of the thumb:treatment with oblique traction[J].J Bone Joint Surg,1979,61(A):260-262.
[21]Surzur P,Rigault M,Charissoux JL,et al.Recent fracture of the base of the first metacarpal base:a study of a series of 138cases[J].Ann Chir Main Memb Super,1994,13:122-134.
[22]Houshian S,Jing SS.Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator:a report of 16cases[J].Hand Surg,2013,18(1):73-78.
[23]Zhang Y,Xu N,Gu W,et al.Two-year follow-up of closed reduction and external fixation treatment of unstable fractures at the base of the first metacarpal[J].Biomedical Research,2017,28(3):1396-1402.
[24]杨辰,陈山林,刘波,等.微型外固定架治疗闭合性第一掌骨基底关节内骨折[J].实用手外科杂志,2013,27(4):315-318.
[25]El-Sharkawy AA,El-Mofty AO,Moharram AN,et al.Management of Rolando fracture by modified dynamic external fixation:a new technique[J].Tech Hand Up Extrem Surg,2009,13(1):11-15.
[26]Giesen T,Neukom L,Fakin R,et al.Modified suzuki frame for the treatment of difficult Rolando fractures[J].Hand Surg&Rehab,2017,36(3):335-340.
[27]Buchler U,McCollam SM,Oppikofer C.Comminuted fractures of the basilar joint of the thumb:combined treatment by external fixation,limited internal fixation,and bone grafting[J].J Hand Surg Am,1991,16:556-560.
[28]Proubasta IR,Sanchez A.Rolando’s fracture:treatment by closed reduction and external fixation[J].Tech Hand Up Extrem Surg,2000,4:251-256.
[29]Byrne AM,Kearns SR,Morris S,et al.‘S’Quattro external fixation for complex intra-articular thumb fractures[J].J Orthop Surg(Hong Kong),2008,16:170-174.
[30]Levy V,Mazzola M,Gonzalez M.Intra-articular fracture of the base of the first metacarpal bone:treatment through a volar approach[J].HAND,2018,13(1):90-94.
[31]张允会,张旭阳,郭凯超,等.T型掌指骨钢板联合拉力螺钉治疗Rolando骨折[J].实用手外科杂志,2017,31(1):113-114.
[32]Uludag S,Ataker Y,Seyahi A,et al.Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb[J].J Hand Surgery(European Volume),2015,40(4):370-373.
[33]吴一,徐永清,师继红,等.T型掌指骨钢板联合克氏针固定治疗Rolando骨折[J].中华手外科杂志,2014,30(6):416-418.
[34]Nonnenmacher J.Osteoshyntesis of fractures of the base of the first metacarpal by an external fixator[in Frech][J].Ann Chir Main,1983,2:250-257.
[35]Proubasta IR,Sanchez A.Rolando’s fracture:treatment by closed reduction and external fixation[J].Tech Hand Upper Extrem Surg,2000,4:251-256.
[36]Mikihiko H,Takuya S.Effect of external fixation for Rolando’s fracture[in Japan][J].J Japan Assoc Ext Fix Limb,2003,14:37-41.
[37]Langhoff O,Andersen K,Kjaer-Petersen K.Rolando’s fracture[J].J Hand Surg,1991,16(4):454-459.
[38]Soyer AD.Fractures of the base of the first metacarpal:current treatments options[J].J Am Acad Orthop Surg,1999,7(6):403-412.
[39]Van Niekerk JLM,Ouwens R.Fractures of the base of the first metacarpal bone:results of surgical treatment[J].Injury,1989,20(6):359-362.
[2]Leibovic SJ.Treatment of bennett’s and rolando’s fractures[J].Tech Hand Upper Extrem Surg,1998,2(B):36-46.
[3]Proubasta IR.Rolando’s fracture of the firstmetacarpal:Treatment by external fixation[J].J Bone Joint Surg,1992,74(A):416-417.
[4]Langhoff O,Andersen K,Kjaer-Petersen K.Rolando’s fracture[J].J Hand Surg,1991,16(B):454-459.
[5]Cooney WP III,Lucca MJ,Chao EY,et al.The kinesiology of the thumb trapeziometacarpal joint[J].J Bone Joint Surg,1981,63(A):1371-1381.
[6]Bettinger PC,Linscheid RL,Berger RA,et al.An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint[J].J Hand Surg,1999,24(A):786-798.
[7]Ollie JE.Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb[J].Hand Clin,2006,22:365-392.
[8]Connell DA,Pike J,Koulouris G,et al.MR imaging of thumb carpometacarpal joint ligament injuries[J].J Hand Surg,2004,29(B):46-64.
[9]Cooney WP III,Chao EY.Biomechanial analysis of static forces in the thumb during hand function[J].J Bone Joint Surg,1977,59(A):27-36.
[10]刘松,陈伟,朱燕宾,等.2010年至2011年中国东部和西部地区第一掌骨基底骨折的流行病学对比分析[J].中华创伤骨科杂志,2017,19(12):1069-1073.
[11]Carlsen BT,Moran SL.Thumb trauma:Bennett fractures,Rolando fractures,and ulnar collateral ligament injuries[J].J Hand Surg,2009,34(A):945-952.
[12]Surzur P,Rigault M,Charissoux JL,et al.Recent fracture of the base of the first metacarpal base:a study of a series of138 cases[In French][J].Ann Chir Main Memb Super,1994,13:122-134.
[13]Liverneaux PA,Ichihara S,Hendriks S,et al.Fractures and dislocation of the base of the thumb metacarpal[J].J Hand Surg Eur Vol,2015,40(1):42-50.
[14]Taichi S,Kevin CC,Steven CH.Operative techniques[J].Hand Wrist Surg(Third Edition),2018:147-154.
[15]Mahoney M,Marsland D,Garagnani L.Rolando and his fracture[J].Trauma,2015,17(1):24-28.
[16]Wiggins HE,Bundens WD.A method of treatment of fracturedislocations of the first metacarpal bone[J].J Bone Joint Surg,1954,36(A):810-819.
[17]刘印文,卫晓恩,高宁阳,等.手法闭合复位经皮穿针内固定治疗第1掌骨基底骨折[J].中医正骨,2014,26(3):54-55.
[18]班照楠,黄富国,顾琪珊,等.闭合复位第一、二掌骨间克氏针固定治疗第一掌骨基底部骨折[J].中华手外科杂志,2015,31(5):351-352.
[19]冯炜,李俊杰,俞立新.闭合复位平行克氏针固定治疗第1掌骨基底部骨折[J].浙江临床医学,2017,19(2):266-267.
[20]Gelberman RH,Vance RM,Zakaib GS.Fractures at the base of the thumb:treatment with oblique traction[J].J Bone Joint Surg,1979,61(A):260-262.
[21]Surzur P,Rigault M,Charissoux JL,et al.Recent fracture of the base of the first metacarpal base:a study of a series of 138cases[J].Ann Chir Main Memb Super,1994,13:122-134.
[22]Houshian S,Jing SS.Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator:a report of 16cases[J].Hand Surg,2013,18(1):73-78.
[23]Zhang Y,Xu N,Gu W,et al.Two-year follow-up of closed reduction and external fixation treatment of unstable fractures at the base of the first metacarpal[J].Biomedical Research,2017,28(3):1396-1402.
[24]杨辰,陈山林,刘波,等.微型外固定架治疗闭合性第一掌骨基底关节内骨折[J].实用手外科杂志,2013,27(4):315-318.
[25]El-Sharkawy AA,El-Mofty AO,Moharram AN,et al.Management of Rolando fracture by modified dynamic external fixation:a new technique[J].Tech Hand Up Extrem Surg,2009,13(1):11-15.
[26]Giesen T,Neukom L,Fakin R,et al.Modified suzuki frame for the treatment of difficult Rolando fractures[J].Hand Surg&Rehab,2017,36(3):335-340.
[27]Buchler U,McCollam SM,Oppikofer C.Comminuted fractures of the basilar joint of the thumb:combined treatment by external fixation,limited internal fixation,and bone grafting[J].J Hand Surg Am,1991,16:556-560.
[28]Proubasta IR,Sanchez A.Rolando’s fracture:treatment by closed reduction and external fixation[J].Tech Hand Up Extrem Surg,2000,4:251-256.
[29]Byrne AM,Kearns SR,Morris S,et al.‘S’Quattro external fixation for complex intra-articular thumb fractures[J].J Orthop Surg(Hong Kong),2008,16:170-174.
[30]Levy V,Mazzola M,Gonzalez M.Intra-articular fracture of the base of the first metacarpal bone:treatment through a volar approach[J].HAND,2018,13(1):90-94.
[31]张允会,张旭阳,郭凯超,等.T型掌指骨钢板联合拉力螺钉治疗Rolando骨折[J].实用手外科杂志,2017,31(1):113-114.
[32]Uludag S,Ataker Y,Seyahi A,et al.Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb[J].J Hand Surgery(European Volume),2015,40(4):370-373.
[33]吴一,徐永清,师继红,等.T型掌指骨钢板联合克氏针固定治疗Rolando骨折[J].中华手外科杂志,2014,30(6):416-418.
[34]Nonnenmacher J.Osteoshyntesis of fractures of the base of the first metacarpal by an external fixator[in Frech][J].Ann Chir Main,1983,2:250-257.
[35]Proubasta IR,Sanchez A.Rolando’s fracture:treatment by closed reduction and external fixation[J].Tech Hand Upper Extrem Surg,2000,4:251-256.
[36]Mikihiko H,Takuya S.Effect of external fixation for Rolando’s fracture[in Japan][J].J Japan Assoc Ext Fix Limb,2003,14:37-41.
[37]Langhoff O,Andersen K,Kjaer-Petersen K.Rolando’s fracture[J].J Hand Surg,1991,16(4):454-459.
[38]Soyer AD.Fractures of the base of the first metacarpal:current treatments options[J].J Am Acad Orthop Surg,1999,7(6):403-412.
[39]Van Niekerk JLM,Ouwens R.Fractures of the base of the first metacarpal bone:results of surgical treatment[J].Injury,1989,20(6):359-362.