中节指骨基底背侧撕脱骨折的手术治疗

Surgical treatment of avulsed fracture of at dorsal base middle phalanx

目的探讨应用克氏针内固定中节基底背侧较大撕脱骨折块和中节指骨基底背侧钻孔缝合治疗中节指骨基底背侧小片撕脱骨折的疗效。方法对60例中36例骨折块较大的中节基底背侧撕脱骨折患者采用骨折复位,0.8mm克氏针内固定骨折块,并首先顺行穿入1.0mm克氏针行近指间关节(pip)平伸位内固定;对24例骨折块小的中节指骨基底背侧撕脱骨折采用骨折复位,中节基底背侧钻孔缝合,同时顺行1.0mm克氏针内固定PIP于平伸位。石膏托外固定掌指关节(MP)80°～90°屈曲位,腕关节背伸位,远指间关节(DIP)平伸位3～4周。术后4～6周拔除内固定骨折块及PIP关节克氏针。结果经术后3～9个月的随访,按指关节主动运动总和(TAM)法评定疗效:优15例,良35例,中10例,骨折全部愈合。结论采用克氏针内固定中节基底背侧较大撕脱骨折块及中节基底背侧钻孔治疗中节背侧小片撕脱骨折的两种手术方法疗效均满意。

Objective To study the treatment outcome of avulsed fracture of at dorsal base middle phalanx.Methods Sixty cases with avulsed fracture of at dorsal base middle phalanx were studied. In 36 cases a comparatively fragment was avulsed from dorsal base middle phalanx. A Φ1.0mm K-wire was placed across the PIP joint at the extension 0° position, and then the fragment was fixed by a Φ0.80mm K-wire. In 24 cases,a small fragment was avulsed from dorsal base middle phalanx and then fragment was fixed by suture.Results Postoperative immobilization of the finger in cast kept the MP joint in 80°-90°flexation,DIP joint in 0°extension.The K-wire was pull out at 4-6 weeks. Results： postoperative follow up from 3 months to 9 months.According to TAM criteria： excellent in 15 cases, good in 35 cases, fair in 10 cases.Conclusion The avulsed fracture of at dorsal base middle phalanx were fixed with K-wire and suture is an easy and effective method for treatment.