弹性外固定架在儿童锤状指治疗中的应用

Application of elastic external fixators in the surgical treatment of mallet fingers in children

目的介绍一种弹性外固定架在儿童锤状指治疗中的应用及体会。方法2003年2月至2008年9月，我们在对31例（31指）儿童锤状指患儿的治疗中，首先用直径0．8～1．0mm的克氏针2根，制成具有弹性的手指外固定架，将伤指固定于近侧指问关节屈曲、远侧指间关节伸直的体位，然后修复伸指肌腱或固定撕脱的骨块，术后4周进行患指主动屈曲功能锻炼，6周后去除外固定架。结果本组患儿31例31指均获随访，随访时间5个月至4．5年。指伸肌腱及骨折均愈合良好，锤状指畸形完全矫正，伤指外形无肿胀，关节活动正常，骨骼生长未受影响，不影响学习及生活。根据TAM（total active movement，TAM）系统评定方法：优25例，良6例，可、差均为0例，优良率100％。结论弹性外固定架作为儿童锤状指治疗的外固定措施是一种操作简单、损伤轻微、固定可靠、治疗有效的方法，临床可以推广。

Objective To retrospectively review the application of elastic external fixators in the surgical treatment of mallet fingers in children. Methods From February 2003 to September 2008, 31 fingers of the thirty patients were treated with surgery. Elastic external fixators was applied to the affected fingers, which were constructed with two 0. 8-1.0 mm Kirschner wires, and were used to keep the proximal interphalangeal joint in flexed position and the distal interphalangeal joint in extended position, After fixation, corrective operations were performed to repair finger extensors and joints. Early active flexion exercise began at 4 weeks after surgery. The external fixtors were removed at the 6th week after surgery. Clinical results were scored using the total active movement （TAM） grading system, Results Thirty-one cases were followed up for 5 months to 4. 5 years. The mallet fingers were successfully corrected. The appearance and function of the fingers were good. Their finger bones grew normally. In the 31 treated fingers, 25 were excellent, and the other 6 were good according to the TAM system, the excellent and good rate was 100%. Conclusions Elastic external fixators, which is used to treat mallet fingers in children, is a simple, minimally invasive, reliable fixation and effective method. It may be applied to clinical extensively.