微型钛板与记忆合金环抱器治疗掌指骨骨折的对比研究

Compare study of tatanium mini-plate and shape memory alloy embracing fixator in the treatment of metacarpal and phalangeal fractures

目的对比分析微型钛板内固定和记忆合金环抱器内固定治疗掌指骨（近中节指骨）骨折的临床疗效。方法采用微型钛板治疗组（A组）66例104处及记忆合金治疗组（B组）61例92处，对比分析两种手术治疗效果。随访3～12个月，平均6个月，以TAFS评分为评价标准，并记录伤口感染、骨折愈合时间、骨折延迟愈合、骨不连、关节僵硬、肌腱粘连、内置物外露等并发症发生情况。结果127例均达骨性愈合。A组（104处骨折）优良率93．29％，B组（92处骨折），优良率79．9％。两组TAFS功能评分结果差异有统计学意义（芹=4．14，P〈0．05），A组明显优于B组。A组延迟愈合3处（2．88％）；B组延迟愈合7处（7．59％）。B组病例延迟愈合率高于A组。A组骨折愈合时间平均31．5d：B组骨折愈合时间平均54．6d。无骨不连发生。两组结果差异有统计学意义（t=2．23，P〈0．05），A组骨折愈合时间明显短于B组，两组术后感染率无差异。结论微型钛板治疗掌指骨骨折在术后关节功能恢复情况、骨折愈合时间、骨折延迟愈合、关节僵硬、肌腱粘连、内置物外露等并发症发生指标上明显优于记忆合金环抱器治疗组．是目前掌指骨骨折较为理想的治疗方法。

Objective To compare the clinical effect of matacarpal and phalangeal fractures by titanium mini-plate and shape memory alloy embracing fixator. Methods 196 fractures of 127 cases were randomly assigned to two groups, group A （ 104 fractures of 66 cases ） was treated by titanium mini- plate, group B （ 92 fractures of 61 cases ） was treated by shape memory alloy embracing fixator. All the cases were followed up for 3 months to 1 year （ average 6 months ）. The result was assessed by TAFS criteria including postoperative infection, fracture union time, delayed union, ununion, joint stiffness, tendon adhesion and internal fixator outcrop complications. Results 127 cases achieved bone union, the excellent and good rate was 93.29%in group A, and 79.09%in group B, two groups has significant statistical difference by TAFS criteria, group A is obviously better than B. 3 delayed union occurred in group A （ 2.88% ） , 7 occurred in B （ 7.59% ）, The delayed union rate in group B was higher than A. The average union time was 31.5 days in group A and 54.6 days in B. Union time of group A was shorter the B. The postoperative infection was not different in both groups. Conclusion Titanium mini-plate is obviously better than shape memory alloy embracing fixator in metacarpal and phalangeal fractures treatment.When judged by such indexes as postoperative functional restoration, postoperative infection, delayed union, fracture union time, joint stiffness, tendon adhesion and internal fixator outcrop and postoperative complications, and it is an optional therapy for metacarpal and phalangeal fracture.