陈旧性骨性锤状指手术方式选择及疗效分析

The optimal selection and treatment outcome of surgical procedures for chronic mallet finger deformity with fractures

目的比较闭合复位与开放复位治疗陈旧性骨性锤状指的疗效差异，初步探讨陈旧性骨性锤状指较为合适的治疗手段。方法自2006年1月至2012年2月期间共有81例陈旧性骨性锤状指患者接受手术治疗，手术时间为受伤后8—21周，分别采用闭合性复位克氏针固定术（A组43例），单纯骨折切开复位克氏针固定术（先经闭合性复位克氏针固定但效果不佳，B组21例），微型骨锚重建伸肌腱止点术（先经闭合性复位克氏针固定但效果不佳，C组17例）。结果术后随访时间为6～24个月，平均11．1个月。A组：优21例，良16例，可4例，差2例；优良率为86．0％。B组：优9例，良9例，可2例，差1例；优良率为85．7％。C组：优6例，良8例，可1例，差2例，优良率82．4％。损伤8～14周患者中，91．9％经闭合复位克氏针固定治疗后骨折愈合；损伤14周以上患者中，79．5％需再次接受切开复位克氏针内固定或微型骨锚重建伸肌腱止点术。结论根据受伤时间的差异，合理应用不同手术方法治疗伸肌腱止点撕脱性骨折锤状指，以期取得较好的疗效。

Objective To evaluate the efficacy of closed reduction and open reduction in the treatment of chronic mallet fracture. Methods From January 2006 to February 2012, 81 patients with chronic mallet fracture were surgically treated. The interval between injury and operating time of these patients ranged from 8 to 21 weeks. Closed reduction and Kirschner wire fixation was carried out in 43 patients （ group A）. For cases when attempts of closed reduction and K-wire fixation did not achieve satisfactory results, simple open reduction and K- wire fixation was done in 21 patients （group B） while open reduction and extensor tendon insertion reconstruction with bone anchor was done in 17 patients （ group C）. Results Postoperatively the patients were follow-up for 6 to 24 months, with an average of 11.1 months. In group A results were excellent in 21 cases, good in 16 cases, fair in 4 cases and poor in 2 cases, with an overall 86.0% satisfactory rate. In group B results were excellent in 9 cases, good in 9 cases, fair in 2 cases and poor in 1 case, with an overall 85.7% satisfactory rate. In group C results were excellent in 6 cases, good in 8 cases, fair in 1 case and poor in 2 cases, with an overall 82.4% satisfactory rate. Fractures healed after dosed reduction and K-wire fixation in 91.9% of the patients whose injuries were 8 to 14 weeks old. In patients whose injuries were more than 14 weeks old, 79.5% needed to have open reduction and K-wire f＇rxation or extensor tendon insertion reconstruction with a mini bone anchor. Conclusion Proper application of different surgical procedures based on the differences in injury time can result in good treatment outcomes in treating mallet finger caused by bony avulsion fracture at the extensor tendon insertion.