微型接骨板和克氏针内固定治疗掌指骨骨折的比较

Comparison of therapeutic effect of Mini-plate and Kirschner internal fixation methods for the treatment of metacarpal and phalangeal fractures

目的：比较分析微型接骨板和克氏针内固定治疗掌指骨骨折对手功能恢复的影响。方法：回顾分析经完整随访的56例掌指骨骨折患者的治疗和康复情况，A组：32例掌指骨骨折患者予以行切开复位交叉克氏针内固定接骨术，术后石膏夹板外固定；B组：24例掌指骨骨折患者予以行切开复位微型接骨板内固定接骨术，术后未用外固定。两组资料经统计学处理，P〉0．05，具有可比性，按照TAM系统评价法要求分别观察测量手指屈曲伸直功能恢复的情况。结果：经过6～12个月（平均9．3个月）的随访，按TAM系统评价法：A组优14例，良9例，中7例，差2例；13组优12例，良6例，中4例，差2例。经统计学Ridit分析检验，u=1．547，两种方法在恢复手功能（掌指关节、近侧指问关节、远侧指间关节的屈伸活动）方面无统计学差异（P〉0．05）。结论：微型接骨板和克氏针内固定均为治疗掌指骨骨折的有效方法，各有优缺点，只要注意适应证的正确掌握和规范操作就能扬长避短，取得良好的疗效。

Objective： To compare and analyze the influence of two internal fixation methods, Miniplate and Kirschner, on the recovery of hand functions in the treatment of metacarpal and phalangeal fractures. Methods： Fifty-six patients with metacarpal and phalangeal fractures who were reviewed in the study were divided into two groups：Group A and Group B. Thirty two patients in Group A were treated with open reduc tion, Kirschner internal fixation and postoperative plaster splint external fixation. Other 24 patients in Group B were treated with open reduction, Mini-plate internal fixation, without any external fixation. The function recovery of flexion and extension of fingers in two groups was evaluated and compared, Results：All the patients were followed up from 6 months to 2 years, with an average of 9.3 months. The TAM evaluation system was used in the present study. In group A, 14 patients reached excellent results, 9 good, 7 fair and 2 poor; and in group B the results were 12,6,4 and 2 respectively. The excellent-and-good rates of the two groups had no statistical difference（according to Ridit analyses, u = 1. 547, P 〉0.05）. The results showed that there were no significant difference in the recovery of hand function between the two methods. Conclusion： Both Mini-plate and Kirschner internal fixation is good methods for the treatment of metacarpal and phalangeal fractures, which has its own advantages and disadvantages. Good therapeutic effects will be gained if we grasp indications and technique of the operation correctly.