微型外固定系统在手部关节内骨折治疗中的应用

Treatment of the fracture of the hand joint with mini external fixator

目的探讨微型外固定系统在手部关节内骨折治疗中的应用和疗效。方法 2007年3月~2010年1月,应用微型外固定系统固定技术治疗手指间关节或掌指关节关节内骨折8例,男5例,女3例;年龄19~63岁,平均31.2岁,示指2例,中指4例,环指2例。微型外固定系统跨关节固定,并将关节间隙撑开至4~5 mm。术后指导患者进行早期手指功能训练。5~6周后去除外固定支架,进行系统功能训练。结果 5例开放性创口术后I期愈合。8例均获随访,随访时间6~15个月,平均9个月,所有骨折均顺利愈合,骨折于术后6~9周临床愈合,受损关节活动度恢复健侧关节的75%~100%,患者均没有明显的关节疼痛,均未发生针道感染,患指外观满意,患者均恢复原有工作。采用美国手外科学会的分级功能评定方法：好6例,一般2例。结论微型外固定系统跨关节固定是治疗手部关节内骨折的有效方法,具有固定可靠,可早期功能锻炼,从而减少关节侧副韧带挛缩、关节僵硬和肌腱粘连等并发症的优点。

[ Objective ] To introduce the method and result of mini external fixator in the treatment of the fracture of the hand joint. [ Methods ] From March 2007 to January 2010, 8 patients used mini external fixator in the treat- ment of the fracture of the MP joint and PIP joint. There were 5 males and 3 females with a mean age of 31 years （19-63 y）. There were 2 index fingers and 4 middle fingers and 2 ring fingers. Early rehabilitation was encouraged. The external fixator was removed 5~6 weeks later. [ Results ] 5 cases of open wounds got phase I healing, the 8 cas- es were followed for 6 months to 15 months. All the fractures healed and the mean time is 6-9 weeks. The mean ac- tive range of motion regained at the joint was 80°-90°. The follow -up results showed that most patients gained good results. Accord to the evaluation method of grading of American Society for Surgery of the Hand： 6 cases are good, 2 is general. [ Conclusion ] From our experience, the surgical technique with mini external fixator is a good method for the treatment of the fracture of the hand joint. Have the advantages of reliable fixation, and early functional exercise, thereby reducing the joint collateral ligament contracture, joint stiffness and tendon adhesions and other complica- tions.