微型钛板与交叉克氏针治疗掌指骨骨折的疗效比较

Comparative study of the clinical results of metacarpal and phalangeal fracture fixation by titanimn miniplates and cross K-wires

目的评价微型钛板和克氏针治疗掌、指骨骨折的疗效。方法对59例80处掌、指骨骨折的患者，随机采用交叉克氏针固定（A组，26例37处）和微型钛板固定（B组，33例43处）。结果术后随访时间为3～12个月（平均7．6个月），所有骨折均达到骨性愈合。根据中华医学会手外科学会上肢部分功能评定试用标准评定：A组优13处，良11处，差13处，优良率为64．9％；B组优26处，良13处，差4处，优良率为90．7％；B组优于A组。感染率比较：A组9处（9／37，占24．3％），B组3处（3／43，占7．0％），B组低于A组。骨折平均愈合时间：A组为7．6周，B组4．6周。术后并发症：B组在关节僵硬、局部不适及肌腱粘连等方面均低于A组。结论微型钛板治疗掌、指骨骨折在术后各项指标上均明显优于交叉克氏针固定。

Objective To assess the clinical results of metacarpal and phalangeal fracture fixation by titanium mini-plates and cross K-wires. Methods 80 metacarpal and phalangeal fractures in 59 cases were randomly assigned to K-wire fixation group （Group A, 37 fractures in 26 cases） and titanium mini-plate fixation group （Group B, 43 fractures in 33 cases）. Results Postoperatively all the cases were followed up for 3 to 12 months （average 7.6 months）. The clinical results of both groups were assessed by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. In group A 13 fractures were graded as excellent, 11 as good and 13 as poor. The excellent and good rate was 64.9%. In group B, 26 fractures were graded as excellent, 13 as good and 4 as poor. The excellent and good rate was 90.7%, being significantly better than that of group A. As for postoperative infection, it occurred in 9 fractures of group A （9/37, 24.3 % ） and in 3 fractures of group B （3/43, 7.0% ）, being significantly lower in group B. The average bone union time was 7.6 weeks for group A and 4.6 weeks for group B. Postoperative complications such as joint stiffness, fracture site discomfort and tendon adhesion were fewer in group B than in group A. Condusion Titanium mini-plate fixation is superior to cross K-wire fixation for treatment of metacarpal and phalangeal fractures when judged by such indexes as postoperative functional restoration of the metacarpophalangeal and interphalangeal joints, postoperative infective rate, average fracture union time and complication rate.