微型外固定系统在手部骨折中的应用

The application of the minifixation system in hand fractures

目的探讨应用微型外固定系统治疗手部骨折的方法及疗效。方法2002年5月～2003年11月,应用Orthofix装置以外固定法治疗25例30处掌、指骨骨折。其中掌骨骨折14例19处,指骨骨折11例(近节指骨6例,中节指骨5例);闭合性骨折15例,开放性骨折10例。横行骨折10例,粉碎性骨折8例,短斜形骨折3例,关节内骨折4例。手术方法是首先在靠近关节处打入第一枚固定针。根据骨折位置、骨长度选择标准型或“L”型针管夹,将其套在第一枚针上。针管夹和皮肤之间的距离保持在5～10mm。然后,根据骨块的大小,以平行孔或相聚孔的方式打入第二枚固定针。根据骨的长度,选择合适长度的连接杆并安放第二套针管夹。然后,松开球形关节和其中一枚针管夹,试行复位,位置满意后,拧紧所有固定螺栓。对于关节内骨折,术后2周开始进行主动功能锻炼。对于关节外骨折,术后次日开始进行主动功能锻炼。记录骨折愈合时间及指间关节的主动活动度(totalactivemotion,TAM法)。结果所有患者均获得随访,时间5～12个月,平均8个月。24例骨折顺利愈合,愈合时间6～12周,平均8周。用TAM法评价术后手指活动度,关节外组优良率95.2%,关节内组优良率75%。术后发生骨折不愈合1例,针道感染3例,钢针折断1例。结论微型外固定系统治疗手部骨折,创伤小,愈合率高,疗效肯定。

Objective To report the method and results of the hand fractures fixed by minifixation system. Methods Twenty-five cases(thirty lesions) of hand fractures were treated with external minifixator from May 2002 to November 2003. Among them, 14(19 lesions) were of metacarpal fractures, 11 cases of phalangeal fractures (6 of proximal phalanges, 5 of middle phalanges). 15 cases were close fractures, 10 were open fractures. There were 10 transverse types, 8 comminuted types, 3 short oblique types, 4 intra-articular types. The first wire was inserted closing to the joint, according to the position of the fracture and the bone length, a standard or 'L' type clamp was applied over the wire and 5-10 mm away from the skin. The second wire was inserted either focally or transversely in respect to the first, according to the length of the fragment. A minifixation rod of proper length was connected. The second set of wires was inserted after that. With the ball joint and one of the clamps fully loosened, the fracture was reduced. If the reduction was satisfied, the clamps and the ball joint had to be locked. Active range of exercise was started two weeks later for the intra-articular fractures, and it could begin right on the first day after operation for extra-articular fractures. Results All patients were followed up for 5-12 months (average, 8 months). 24 fractures healed successfully, and the average union time was 8 weeks with a range of 6 to 12 weeks. According TAM standard, the overall good-excellent rate of joint function was 95.2% for the extra-articular fractures, while 75% for the intra-articular fractures. One had nonunion, one of pin breakage and 3 of pin-track infections. Conclusion The use of the minifixation system is an alternative method for the hand fractures, especially for the metacarpal ones. It also has some advantages on both of the comminuted fractures and complicated intra-articular fractures.