微型外固定架结合有限切开复位内固定治疗手部关节内骨折

Limited open reduction and internal fixation combined with mini external fixator to intra-articular fracture of the hand

目的 探讨微型外固定架结合有限切开复位内固定治疗手部关节内骨折的方法及疗效。方法 2002年5月至2007年5月，应用微型外固定架结合有限切开复位内固定治疗手部关节内骨折26例，男21例，女5例；年龄15-52岁，平均25．5岁。涉及近侧指间关节13例、拇指指间关节2例、掌指关节6例、拇指掌指关节5例。合并关节外掌骨骨折3例、舟骨骨折1例、前臂骨筋膜间室综合征1例。所有病例均采用Oahofix微型外固定架，内固定包括克氏针、细钢丝、可吸收缝线等。结果 全部病例随访6-30个月，平均11．5个月。术后骨折均愈合，愈合时间5-12周，平均7周。随访时X线片显示指骨短缩或旋转畸形2例，关节面不一致（1mm以内）或关节间隙狭窄3例，其中1例于术后1年半因创伤性关节炎行人工关节置换术。所有损伤关节均无不稳定发生。以ATM标准评定手术后患指运动功能，优8例，良13例，可3例，差2例，优良率81％。结论 微型外固定架结合有限切开复位内固定治疗手部关节内骨折方法可靠、有效。指骨短缩或旋转畸形、关节间隙狭窄是主要并发症。

Objective To investigate the method and clinical outcome of limited open reduction and internal fixation combined with mini external fixator to intra-articular fracture of the hand. Methods From May 2002 to May 2007, twenty-six patients （21 males and 5 females） with intraarticular fracture of the hand were treated. Metacarpophalangeal joint was involved in 11 cases, proximal interphalangeal joint was involved in 13, and interphalaugeal joint of thumb in 2. The patients aged from 12 to 52 years, averaged 25.5 years. Concomitant bone injury included metacarpal fracture in 3 cases, and scaphoid fracture in 1. Orthofix mini external fixator was used in all cases, and Kirschner wire, mini wire and absorbable suture were used for internal fixation. Concomitant fracture should be treated simultaneously with shape memory alloy, Kirschner wire, or plate-screw system. Results The patients were followed up for 6-30 months, averaged 11.5 months. X-ray identified fracture union in all cases, and the average union time was 7 weeks ranging 5- 12 weeks. Phalange shortening or rotation was noted in 2 cases, joint incongruity （less than 1 mm） and joint space narrowing in 3 respectively. A proximal interphalangeal joint replacement was performed in one ease with traumatic arthritis 1.5 years after surgery. 17 patients returned to their original living styles and occu- pations. ATM standard was used to evaluate the motion function of the injured fingers, which comprised of 8 excellent results, 13 good results, 3 fair results and 2 poor results. The overall good-excellent rate of joint motion function was 81%. No instability occurred in all joints at the follow-up. Conclusion Limited open reduction and internal fixation combined with mini external fixator is a reliable and effective method for intra-artieular fracture of the hand, and clinical outcome is promising. Major problems, such as bone shortening, rotation deformity and joint space narrowing, still exist.