闭合穿针治疗掌指关节周围部位骨折

Closed reduction and percutaneous K-wire fixation for treatment of periarticular fractures at the metacarpophalangeal joint

目的探讨闭合穿针治疗掌指关节周围部位骨折的临床疗效。方法2005年以来，对17例掌骨颈或近节指骨基底部骨折患者，采用C型臂X线机透视下闭合复位克氏针内固定治疗。单部位骨折11例，其中掌骨头或颈部骨折7例，近节指骨基底部骨折4例；多部位骨折6例，其中2处以上掌骨颈骨折3例，2～5指近节指骨基底部均骨折1例，2～4指近节指骨基底部均骨折1例，第五掌骨颈骨折伴环指近节指骨基底部骨折1例。均为闭合性骨折。急诊手术4例，伤后5d内手术12例，伤后11d手术1例。术后2～3周拆除石膏，4周拔克氏针。结果术后X线片显示骨折均达到良好复位。随访6～9个月，骨折愈合良好。手功能按TAM系统评定法评定：优13例，良4例。结论闭合穿针治疗掌指关节部位骨折创伤小、方法简单、疗效佳，是治疗掌指关节部位骨折理想的方法。

Objective To assess the clinical outcomes of treating periarticular fractures of the metacarpephalangeal joint with closed reduction and percutaneous K-wire fixation. Methods Since 2005, 17 cases of metacarpal neck fractures or proximal phalanx base fractures were treated by dosed reduction and pereutaneous K-wire fixation under fluoroscopic monitoring. There were 11 simple fractures including 7 at the metacarpal head or neck and 4 at the proximal phalanx base. Six cases had fractures involving multiple digits. There were 3 cases of metacarpal neck fractures at more than 2 digits, 1 case of proximal phalanx base fractures involving digit 2 to 5, 1 case of proximal phalanx base fractures of digit 2 to 4, and 1 case of metacarpal neck fracture of digit 5 and proximal phalanx base fracture of digit 4. All the fractures were close fractures. Four cases were operated the day of the injury, 12 cases at 5 days after the injury, and 1 case at 11 days after the injury. Cast was removed 2 to 3 weeks postoperatively. K-wires were removed 4 weeks postoperatively. Results Postoperative X-rays showed good reduction in all cases. Follow up period ranged from 6 to 9 months. All the fractures were well healed. The hand function was evaluated by TAM system which was graded as excellent in 13 cases and good in 4 cases. Conchtsion Close reduction and percutaneous pinning is an ideal way to treat periarticular fractures of the metacarpophalangeal joint. It is minimnally invasive, simple and effective.