微型外固定系统在掌指关节Pilon骨折治疗中的应用

Treatment of the Pilon fracture of the metacarpophalangeal joint with mini external fixator

目的介绍切开复位局限性内固定与微型外固定架相结合的方法治疗掌指关节的Pilon骨折。方法采用切开复位的方法恢复关节面平整度，用直径约0．8—1mm细克氏针进行不超关节的局限性固定，应用微型外固定架进行超关节的加强固定，并将关节间隙撑开约1—2mm。随访中指导患者早期进行手部功能锻炼。4—6周拆除外固定架，6—8周拔除内固定克氏针。通过x线片，观察骨折愈合情况以及关节面的平整度，通过测量手指关节活动度和手指捏力进行手功能评定，结合患者主观感觉和主观满意度评分，综合评价手术疗效。结果平均随访时间11．8个月（7．8～14．2个月）。16例患者骨折均顺利愈合，愈合时间6—8周。x线片示关节面平整度良好。患指总关节活动度（掌指关节＋近侧指间关节＋远侧指间关节，MP＋PIP＋DIP）达到正常侧的80％～97％，手指捏力达正常侧75％以上。其中2例出现近指间关节伸直受限，分别为受限10°和20°。患者均没有明显的关节疼痛，均未发生针道感染，患者主观满意度良好。结论切开复位局限内固定与微型外固定架相结合的方法是治疗掌指关节Pilon骨折的有效方法。外固定架在治疗中起到协助复位，加强固定，利于早期功能锻炼，预防关节囊和侧副韧带的挛缩、减轻关节粘连等作用。

Objective To introduce a surgical technique combined with mini external fixator with K-wires internal fixation in the treatment of the Pilon fracture of the MP joint. Methods The open reduction and K-wires internal fixation were used to stabilize the fracture and mini external fixator were used to assist the reduction and fixation. Early rehabilitation was encouraged. The external fixators were removed 4 - 6 weeks later and the K-wires were removed 6 - 8 weeks later. Roentgenograph was taken to check the healing of the bone and the smooth of the articular surface. Total active movement, pinch strength of the injured digit were measured to assess the results. Subjective feeling and satisfaction were also evaluated, Results The mean follow-up is 11, 8 months （range ,7.8 - 14, 2months）. All the fractures healed and the mean time is 6 - 8 weeks. Roentgenograph showed the articular surface is smooth. The follow-up results showed that most patients gained good results. The mean active range of motion regained at the MP joint was 80°（ range,50° - 95°）, The mean total active motion of the injured digit was 225° （ range, 190° - 270°） ,about 80% -97% of the normal side. The questionnaire showed, that all patients were satisfied with thetreatment. Few complication was happened in this group, Conclusions From our experience, the surgical technique combined mini external fixator with K-wires internal fixation is a good method for the treatment of the Pilon fracture of the MP joint, The advantages of mini external fixator is helpful in the reduction, fixation, earlier rehabilitation, preventing the contracture and adhension of the MP joint .