手指关节内骨折的治疗

Treatment of intra-articular fractures of the fingers

目的探讨手指关节内骨折脱位的内固定方法及其疗效。方法1994年6月—2007年1月,对25例28处手部关节内骨折的患者,分别采用张力带钢丝、微型螺钉和克氏针夹扣法固定的方法进行治疗。并比较三种固定方法在近节指骨基底撕脱性骨折、近侧指间关节各型骨折的应用选择及效果。结果术后随访3个月～11.5年,平均6.4年。术后28处骨折均愈合。根据主观和客观征象进行评定:优25处,良3处。X线片征象显示:优23处,良5处(为陈旧骨折)。手指关节活动度为55°～110°,平均70°。结论对手指关节内骨折,应重视骨折的精确复位和关节周围韧带的保护、修复,指间关节侧方骨折脱位采用张力带钢丝固定或微型螺丝钉固定,指间关节背侧和掌侧撕脱性骨折采用克氏针夹扣法固定可获得较满意的疗效。

Objective To investigate the treatment options and outcomes of intra-arficular fractures of the fingers. Methods Twenty-eight intra-arficular fractures of the fingers in 25 patients treated from June 1994 to January 2007 were analysed. Tension band fixation, mini-serew fixation and double Kirschner wire fixation were used. Applications and results of the 3 fixation techniques in avulsion fractures of the proximal phalanx base and various types of fractures of the proximal interphalangeal joint were analysed and compared. Results Pestoperative follow-up ranged from 3 months to 11.5 years （mean 6 years and 4 months）. Bone union was obtained in all the fractures. Twenty-five of the 28 fractures had an excellent and 3 had a satisfactory result on clinical examination. The average range of motion for the involved joint was 70° （range, 55° to 110°）. Conclusion Precise reduction and internal fixation of the fractured pieces and preservation of pariarticular ligaments were important in managing intra-articular fractures of the phalanx. Satisfactory treatment outcomes can be obtained by using tension band fixation or mini-serew fixation in lateral fracture-dislocation of the interphalangeal joint and using double Kirschner wire fixation in dorsal or volar avulsion fractures of the PIP joint.