微型钢板与克氏针在掌指骨开放性骨折急诊治疗中的疗效比较

THE CURATIVE EFFECT COMPARISON OF MINIATURE STEEL PLATE WITH GRAM AND NEEDLE IN PALM FINGER OPEN FRACTURES IN THE EMERGENCY TREATMENT

目的分析微型钢板与克氏针二种不同内固定方法在急诊治疗掌、指骨开放性骨折的临床效果。方法回顾分析该科2011年7月—2013年12月经手术治疗的掌指骨开放性骨折患者91例（126处）,根据内固定治疗的方式分为微型钢板组和克氏针组,术后随访6～12个月,平均8.2个月,分析二组骨折愈合情况、临床愈合时间、术后并发症及功能情况,进行疗效价。结果微型钢板组骨折愈合率为96.8%,克氏针组骨折愈合率为95.2%,二组差异无统计学意义（P〉0.05）;微型钢板组临床愈合时间短于克氏针组（P〈0.05）;二种内固定方法均有不同程度的并发症,各种并发症的发生率有差异;按照TAFS评分标准评定优良率,克氏针组与微型钢板组患者掌骨关节活动的功能优良率比较差异有统计学意义（P〈0.05）,微型钢板组的临床疗效明显好于克氏针组,近节指骨和中节指骨功能优良率,二组间差异无统计学意义（P〉0.05）。结论克氏针和微型钢板内固定适应证并不完全相同,均有各自优缺点,在急诊条件下开放性掌指骨折的内固定方法应根据骨折的具体情况（部位、类型、软组织损伤情况）而定,以牢固可靠为原则,进行灵活选择,才会达到最好的临床效果。

Objective To analyze the clinical effect of needle and miniature steel plate with two different internal fixation methods in the emergency department for the treatment of palm,finger bone open fracture.Methods Totally 91 cases of palm phalanx of surgical treatment of open fractures patients from July 2011 to December 2013 were retrospectively analyzed.According to the internal fixation treatment way of the needle,the patients were divided into micro steel group and gram needle group,the patients were followed up for 6-12 months after treatment,with an average of 8.2 months.The fracture healing,clinical healing time,postoperative complications and function were analyzed in the two groups,then the curative effect was evaluated.Results The fracture healing rate in micro steel group was 96.8%,95.2%in gram needle group,there was no statistical difference between the groups（P〉0.05）.Clinical healing time of miniature steel plate group was short than semi-detached-sceptical like needle group（P〈0.05）.Two kinds of internal fixation methods showed different degrees complications,there were differences in the incidence of various complications between two groups.In accordance with the TAFS grading standard rate,the metacarpal joint activity function of patients in two groups was different（P〈0.05）,the clinical curative effect of mini plate group was obviously better than semi-detached-sceptical like needle group,while the nearly section phalanx and finger function were no statistically significant difference between the two groups（P〉0.05）.Conclusions Gram and micro needle plate internal fixation of indication are not exactly the same,both have their respective advantages and disadvantages.Under the condition of emergency,open palm phalanx fracture internal fixation methods should be selected according to the actual circumstances of the fracture（area）,type,soft tissue injury.Based on principles of solid and reliable to choice,will reach the best clinical effect.