应用AO微型钛板治疗掌指关节周围骨折

Application of AO miniplate and screw in the treatment of metacarpophalangeal joint periarticularfractures

目的评估切开复位，应用AO微型钛板螺钉治疗不稳定掌指关节周围骨折的治疗效果。方法2006年4月至2010年8月间经微型接骨板螺钉治疗掌指骨关节周围骨折302例。患者均随访8周以上，在末次随访时，根据TAM评分标准、平均掌指关节PROM、quick-DASH评分、握力、捏力和Kapandji评分等对治疗效果进行评定。应用全关节主被动活动优良率、掌指关节被动活动度、并发症发生率、quick—DASH评分等4项评估指标，在功能效果方面，将AO钛板固定与以前应用手法整复，石膏托固定，切开复位克氏针固定等传统治疗方法进行比较。结果术后平均随访4．6个月。X线显示骨折线基本消失时间平均8．2周。103例（34．1％）掌指关节功能完全恢复。掌骨头合并近节指骨基底骨折术后并发症发生率及肌腱粘连发生率均高于单纯掌骨头骨折或近节指骨基底骨折。与以前应用传统治疗方法进行对比，AO钛板治疗组各项指标均优（握力恢复94．5％，捏力恢复88．6％，Kapandji评分90％，P〈0．01）。结论掌指关节周围骨折解剖部位复杂，术后易产生肌腱粘连，关节僵硬及创伤性关节炎等并发症，传统方法治疗效果较差。AO微型接骨板螺钉系统可明显提高其治疗效果。

Objective To evaluate the clinical efficacies for open reduction and internal fixation of unstable periartieular fractures of metacarpophalangeal joint （MCP） with the AO miniature plate system. Methods A total of 265 patients （ 172 males and 93 females） with 302 MCP periarticular fractures were retrospectively reviewed. Their mean age was 32. 5 years old （ range ： 17 - 59 ）. The standard internal fixation treatment method was established on the basis of the AO/ASIF Comprehensive Classification of Fractures. A ＂T＂ shape plate, double-row-plate or a condylar plate was used for A2, A3, C1, C2 type fractures. Screws alone were used for B type fractures. Active and passive flexion and extension exercises at Day 3 post-operation within the limits of patient pain tolerance. All patients were evaluated regarding the total active motion （TAM） score, average PROM, quick-DASH score, the power of gripping, pinching and Kapandji score. Results The patients were followed up for an average of 4. 6 months （range：4- 24）.Radiological examinations showed that the fracture line disappeared in an average of 8.2 weeks （ average ： 8.2）. According to TAM rating criteria, the functions of hands were as follows： excellent （n = 113）, good （n = 136） and poor （n =53）. The fair rate was 82. 8%. The average PROM of MP joint was 82. 30 ±4. 7° and the average quick-DASH score 17.4. Contrast to the health side, the power of gripping recovered for 94. 5% and pinching for 88. 6%. The Kapandji score was 90%. A total of 103 MCP （34. 1% ） completely recovered. Contrasting between the head of metacarpal fracture combined the base of proximal phalangeal fracture and alone the head of metacarpal fracture or the base of proximal phalangeal fracture, the post- operative rates of complications and tendon adhesion were higher. As compared with traditional methods, each of the above parameters had statistic significances （ P 〈 0. O1 ）. Conclusion Because of complex anatomic structures, the MCP periarticular fractures have such complications as tendon adhesion, joint stiffness and post-traumatic arthritis, etc. The traditional treatment method is less effective. The AO miniplate and screw system provides rigid and stable fixation so that it is a preferred technique in the treatment of MCP periarticular fractures.