闭合穿针石膏夹板和开放复位抽出钢丝治疗锤状指的疗效比较分析

CLINICAL CONTRAST OF PERCUTANEOUS PINNING WITH PLASTER SPLINT AND OPEN REDUCTION AND PULLING OUT WIRE IN THE TREATMENT OF MALLET FINGERS

目的探讨闭合穿针石膏夹板法和开放复位抽出钢丝法治疗锤状指的临床疗效差异。方法2002年12月-2007年9月,收治72例锤状指患者。38例采用开放复位抽出钢丝法治疗(A组):男34例,女4例;年龄(26.0±8.5)岁。致伤原因:运动伤33例,摔伤5例。示指2例,中指11例,环指18例,小指7例。受伤至手术时间为(6.1±3.1)d。34例采用闭合穿针石膏夹板治疗(B组):男26例,女8例;年龄(28.1±10.7)岁。致伤原因:运动伤31例,摔伤3例。示指1例,中指9例,环指15例,小指9例。受伤至手术时间为(6.3±3.6)d。两组伤指均有典型锤状畸形,X线片示远节指骨背侧基底部撕脱骨折。结果A、B组手术时间分别为(61.8±12.8)min及(7.0±2.6)min。术后A、B组患者均获随访,随访时间6～24个月,平均11.9个月及13.2个月。A组术后3例切口感染,其他患者切口均Ⅰ期愈合;1例术后6d出现指掌侧皮肤压疮,对症处理后愈合。36例骨折于术后(47.6±8.7)d达骨性愈合,2例对位不良形成假关节,二期行伸肌腱附着点重建后功能改善。按照主动活动度(totalactive movement,TAM)系统评定方法评定,优10例,良18例,可8例,差2例,优良率为73.7%。B组术后无针道感染发生,骨折均于术后(27.7±3.9)d达骨性愈合。TAM系统评定优19例,良13例,可2例,优良率为94.1%。两组手术时间、术后并发症、骨折愈合时间及功能优良率比较,差异均有统计学意义(P<0.05)。结论闭合穿针石膏夹板治疗锤状指与传统抽出钢丝法相比,具有操作简便,创伤小,并发症少的优点。

Objective To compare differences in the clinical outcomes between percutaneous pinning with plaster splint and open reduction and pulling out wire in the treatment of mallet fingers. Methods From December 2002 to September 2007, 72 patients with mallet fingers were treated. They were divided into two groups： group A and group B. In group A, 38 patients were treated by open reduction and pulling out wire, 34 males and 4 females, aged （26.0 ± 8.5） years. Among them, 2 patients were injured in the index finger, 11 in the middle finger, 18 in the ring finger and 7 in the little finger. Thirtythree patients suffered from sports injuries, 5 from falling wounds. The average time between the injury and the surgery was （6.1 ± 3.1） days. In group B, 34 patients were treated by percutaneous pinning with plaster splint, 26 males and 8 females, aged （28.1 ± 10.7） years. Among them, 1 patient was injured in the index finger, 9 in the middle finger, 15 in the ring finger and 9 in the little finger. Thirty-one patients suffered from sports injuries, 3 from falling wounds. The average time between the injury and the surgery was （6.3 ± 3.6） days. All the fingers had typical mallet malformation, and X-ray films showed avulsed fractures of distallsegment phalanxes at the dorsal basilar part. Results The operation time was （61.8 ± 12.8） minutes in group A and （7.0 ±2.6） minutes in group B. All patients in both groups were followed up for 6-24 months （11.9 months on average in group A and 13.2 months in group B）. In group A, apart from 3 patients who had flap necrosis and infection, all the other patients obtained healing by first intention. One patient had palmar skin ulcer at 6 days after the operation and healed after proper treatment. Thirty-six patients gained bone union at （47.6 ± 8.7） days postoperatively and 2 patients had pseudarthrosis, which improved after reconstruction of the extensor tendon attachment point. According to the total active movement （TAM） functional assessment system, 10 cases were excellent, 18 good, 8 fair and 2 poor, with the choiceness rate of 73.7%. In group B, all incisions obtained healing by first intention without pin-track infection, flap necrosis and migration of the pins and gained bone union at （27.7 ± 3.9） days after the operation. According to the TAM functional assessment system, 19 cases were excellent,13 good and 2 fair, with the choiceness rate of 94.1%. There were significant differences between the two groups in operation time, complications, healing time and choiceness rate （P 〈 0.05）. Conclusion Percutaneous pinning with plaster splint is simple in operation and has smaller incisions and fewer complications compared with open reduction and pulling out wire, and proves to be a useful way in the treatment of mallet fingers.