克氏针与微型钢板置入内固定治疗掌指骨骨折的比较

Comparison between Kirschner wire and mini-plate internal fixation in the treatment of metacarpal and phalangeal fractures

背景:一般认为,微型钢板置入内固定治疗掌指骨骨折较克氏针效果更优,但这些报道多就手部掌指骨骨折总体范围进行比较,而未考虑不同节段掌指骨局部解剖特点及骨折的部位、类型等因素。目的:将掌指骨骨折按局部解剖节段分组,对应比较克氏针与微型钢板置入内固定治疗掌指骨骨折的疗效。方法:随访克氏针置入内固定治疗掌指骨骨折52例74处,微型钢板置入内固定治疗掌指骨骨折38例49处,按掌骨、近节指骨、中节指骨分组对应比较,从骨折愈合情况、功能恢复情况及伤口感染情况3方面进行疗效评价。结果与结论:微型钢板治疗掌骨骨折优势明显,可优先选用;治疗近节指骨骨折微型钢板总体占优,但近节指骨远段及头部骨折宜采用交叉克氏针内固定更有利于患指功能恢复;治疗中节指骨骨折应优先选择克氏针;克氏针置入内固定在治疗某些掌指骨骨折病例如末节指骨骨折、关节内骨折、严重粉碎性骨折等有特殊优势。

BACKGROUND：With metacarpal and phalangeal fractures being more common clinical cases,surgical treatment with mini-plate fixation and Kirschner wire are the most widely used.How to rational use of internal fixation in treatment of metacarpal and phalangeal fracture according to the fracture site,type and so on in order to achieve the best efficacy is very important.OBJECTIVE：To compare retrospectively the treatment efficacies between Kirschner wire and mini-plate internal fixation for metacarpal and phalangeal fractures to provide clinical guidance.METHODS：Fifty-two patients with 74 Kirschner wire internal fixation and 38 patients with 49 mini-plate internal fixation were followed up.All patients were grouped and compared within the metacarpal,proximal phalanx and middle phalanx fracture.Healing period,functional recovery and situation of wound infection were evaluated.RESULTS AND CONCLUSION：Mini-plate internal fixation is superior in the treatment of metacarpal fractures.Kirschner wire is better in the treatment of proximal phalanx,and favorites to functional recovery of distal and proximal phalanx head fracture.Kirschner wire should be selected for the treatment of phalanx fracture whereas Kirschner wire is superior for certain kinds of injuries such as distal phalanx fracture,intra-articular fractures,and severe comminuted fractures.