Orthofix微型外固定架结合操纵杆技术微创撬拨复位有限内固定治疗关节部位的掌指骨骨折

Orthofix mini external fixator combined with lever technique for minimally invasive prying reduction and limited internal fixation in the treatment of metacarpal and phalangeal fractures at joint sites

目的探讨Orthofix微型外固定架结合操纵杆技术微创撬拨复位有限内固定治疗关节部位的掌指骨骨折的临床疗效。方法自2014年10月至2017年6月我们应用微型外固定架技术牵拉恢复关节对位,初步复位骨折,再应用操纵杆技术微创撬拨复位,恢复关节面平整,有限克氏针内固定,共治疗34例36处关节内或关节周围的掌指骨骨折,评估骨折愈合及手功能恢复情况。结果所有患者获得6~10个月的短期随访,其中21例获得10~30个月的长期随访,术后骨折全部愈合,愈合时间为5~12周,平均7.3周;按TAM标准评定手指活动度,短期随访的优良率达82.4%,长期随访的优良率达90.5%;5例患者短期随访手指活动度为中,其中2例术后10个月再次手术松解,长期随访功能良。1例患者不能配合功能锻炼,随访手指活动度为差。结论该方法治疗关节部位掌指骨骨折,临床疗效满意。微创,不增加关节部位软组织粘连;固定可靠,满足早期功能锻炼的需要;美观,无明显关节部位手术瘢痕;手部关节僵硬的发生率低。

ObjectiveTo investigate the clinical efficacy of Orthofix mini external fixator combined with lever technique for minimally invasive prying reduction and limited internal fixation in the treatment of metacarpal and phalangeal fractures at joint sites.MethodsFrom October 2014 to June 2017,we applied mini external fixator technique to pull and restore joint alignment,then lever technique for minimally invasive prying reduction to restore articular surface,and limited internal fixation to treat 36 metacarpal and phalangeal fractures at joint sites in 34 cases.Fracture healing and hand function recovery were assessed.ResultsAll the patients obtained short-term follow-up for 6 to 10 months,of which 21 cases obtained long-term follow-up for 10 to 30 months.All the fractures healed after operation.The healing time was 5 to 12 weeks,with an average of 7.3 weeks.According to TAM criteria,the excellent and good rate of short-term follow-up was 82.4%,and the excellent and good rate of long-term follow-up was 90.5%.5 patients had moderate finger activity during short-term follow-up,of which 2 were reoperated after 10 months and had good long-term follow-up function.One patient was unable to cooperate with functional exercise,and the follow-up showed poor finger activity.ConclusionThe method is effective in the treatment of metacarpal and phalangeal fractures at joint sites.This technique is minimally invasive,which does not increase the soft tissue adhesion of joint.The reliable fixation can meet the needs of early functional exercise.The injured hand has good appearance without obvious surgical scar at joint sites and the incidence of hand joint stiffness is low.