限制背伸支具治疗近指间关节背侧骨折脱位

Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint with the extension block splint

目的：评价限制背伸支具治疗近指间（ proximal interphalangeal，PIP ）关节背侧骨折脱位的效果。方法2009年9月至2013年9月，对48例PIP关节背侧骨折脱位患者采用阶段性限制背伸支具治疗，随访其远期功能情况，记录关节活动范围。采用TAM 评分进行手指客观运动功能评价，采用 VAS 评分进行主观满意度评价。结果48例均获4～48个月随访，平均18个月。骨折全部愈合；关节复位满意；PIP关节屈曲110°，伸直0°；TAM评分：优48例，优良率100%；VAS主观满意度9.9分。侧方不稳定且开口征＜30°的4例，支具治疗后无明显侧方不稳定，开口征＜15＆#176;，除侧方梭形膨胀外，无其它并发症。结论限制背伸支具治疗PIP关节背侧骨折脱位方法简单，效果可靠。

Objective To evaluate the effects of the extension block splint for dorsal fracture-dislocation of the proximal interphalangeal （ PIP ） joint. Methods From September 2009 to September 2013, 48 patients with dorsal fracture-dislocation of the PIP joint were treated with the extension block splint in stages. The long-term functional recovery was evaluated, and the joint range of motion was recorded in the follow-up. The total active movement （ TAM ） examination was performed to assess the objective motion function of the ifnger, and the Visual Analogue Scale （ VAS ） was used to evaluate the subjective satisfaction. Results All the 48 patients were followed up for a mean period of 18 months （ range;4-48 months ）. Bone union was achieved in all the cases, and satisfactory joint reduction was obtained. The lfexion and extension of the PIP joint were 110 and 0 degrees respectively. According to the TAM examination, there were 48 excellent cases, and the excellent and good rate was 100%. The VAS score is 9.9 points. Lateral instability was noticed in 4 cases, and the opening was less than 30 degrees. After the treatment of the extension block splint, no obvious lateral instability was found and the opening became less than 15 degrees. There were no complications, except for lateral fusiform swelling. Conclusions The treatment of dorsal fracture-dislocation of the PIP joint with the extension block splint is a simple procedure, with excellent outcomes.