应用微型钢板与交叉克氏针融合手指近指间关节的疗效对比

Comparative study of clinical outcome of proximal interphalangeal joint arthrodesis fixed by mini-plates and cross K-wires

目的探讨应用微型铜板螺钉与交叉克氏针融合手指近指间关节的手术疗效。方法对53例79指近指间关节内骨折、骨缺损患者，分别采用微型钢板螺钉和交叉克氏针固定进行关节融合，其中A组30例47指行微型钢板螺钉固定，B组23例32指行交叉克氏针固定。术后分别对并发症、骨愈合情况以及功能恢复进行比较。功能恢复情况按照TAM功能评定标准进行比较。结果术后随访4～24个月，平均11个月。A组无感染及皮肤坏死，无延迟愈合、骨不连及旋转畸形。融合关节临床愈合时间为6～8周，平均7．3周，X片示骨性愈合时间为8～9周；B组针道感染3指，旋转畸形3指．延迟愈合4指，无骨不连。融合关节，临床愈合时间为7～15周，平均11．2周。X片示骨性愈合时间为10～16周。优良率A组为90．7％，B组为67．1％。术后并发症：A组在邻近关节僵硬、局部不适及肌腱粘连等方面均低于B组。结论微型铜板固定近指间关节融合明显优于交叉克氏针固定。

Objective To compare of the effect of hand function recovery of proximal interphalangeal joint arthrodesis fixed by mini-plates and cross K-wires. Methods Totally 53 cases, 79 fingers, with intra-articular fracture and bone defects on proximal interphalangeal joint were included in the study. In Group A, 30 cases, 47 fingers, were fixed by mini titanium plate. In Group B, 23 cases, 32 fingers, were fixed by cross K-wires. Postoperative complications, bone healing status and finger function were assessed. The clinical results were evaluated by using the Total Active Motion （TAM） criterion of the finger movement. Results All the patients were followed-up for 4 to 24 months, with an average time of 11 months. In group A, there was no infection, skin necrosis, nonunion or deformed union occurred.Clinical union of the arthrodesis took 6 to 8 weeks, with an average time of 7.3 weeks, while bone union on X- ray was achieved by 8 to 9 weeks. In group B, there was pin tract infection in 3 fingers, rotation deformity in 3 fingers and delayed union in 4 fingers. There was no nonunion occurred. Clinical union of the arthrodesis took 7 to 15 weeks, with an average time of 11.2 weeks, while bone union on X-ray was achieved by 10 to 16 weeks. According to the TAM evaluation criteria, in group A, the overall satisfactory rate was 90.7%, while the rate was 67.1% in Group B. It provided more comfort, less stiffness of adjacent joints and tendon adhesion in group A than that in group B. Conclusion Mini-plates is better fixture of proximal interphalangeal joint arthrodesis than K-wires.