AO微型钢板内固定治疗指骨骨折术后功能评价

Phalangeal fractures treated with AO miniature-plate

目的 评价AO微型钢板内固定治疗指骨骨折的术后功能，并探讨可能影响功能恢复的因素。方法对2003年9月至2008年8月间39例（40指）行微型钢板内固定并取出且获得随访的指骨骨折患者临床资料进行回顾性分析。并对随访患者进行满意度测评，采用Tang提出的手功能评定标准进行功能评价，并分析年龄、指别、钢板类型、骨折类型等与功能评级的关系。结果术后随访3～63个月（平均25个月）。患者满意度评价：23．1％（9／39）的患者满意，23．1％（9／39）的患者基本满意，35．9％（14／39）的患者欠满意，17．9％（7／39）的患者不满意。患指术后功能按Tang手功能标准评定：优＋5指，优-1指，良＋4指，良-5指，中14指，差7指，失败4指。无骨不愈合、骨不连、钢板断裂等并发症发生。低龄组（≤45岁）的功能评级明显优于高龄组（〉45岁）（P〈0．01）。拇指与其他四指功能级别有明显差异，拇指功能恢复要比其他四指差。软组织或关节面损伤、开放或粉碎性骨折以及骨折类型等风险因素对功能评级在统计学上没有影响。结论微型钢板可以为不稳定的、复杂的指骨骨折提供稳定可靠的内固定。低龄患者的功能恢复明显优于高龄患者，拇指功能恢复明显低于其他四指。指骨骨折术后指关节容易发生僵硬。

Objective To evaluate the postoperative functions of phalangeal fractures treated with AO miniature-plates. Methods From September 2003 to August 2008, 39 patients with 40 phalangeal fractures were treated by open reduction and internal fixation with AO miniature-plates which were routinely removed. We retrospectively reviewed their outcomes by a new assessment system on active range of motion, grip strength and quality of motion. Results Postoperative follow-ups ranged from 3 to 63 months, with an average of 25 months. One plate was removed ahead of time because it had been exposed. Two cases had to undergo digital amputation because of severe infection and reinjury, respectively. Their postoperative hand functions were graded as excellent in 6 digits （15.0%）, good in 9 digits （22. 5% ）, fair in 14 digits （35.0%）, poor in 7 digits （17.5%）, and failed in 4 digits （10. 0% ） . There was no nonunion, delayed union, or hardware failure. The functional grading was significantly better in the young group （≤45 yeas old） than in the old group （〉 45 years old） （ P 〈 0. 01）. Functional recovery of the thumb was significantly worse than that of other fingers. Fracture type, soft tissue injury, and intra-artieular injury had no statistically significant influence on the functional grading. Conclusions The AO mini-plate can provide rigid and firm fixation for unstable and complicated phalangeal fractures. Old patients and the thumb tend to have poorer prognosis. In spite of early postoperative mobilization, joint stiffness still seems a big problem.