两种多角度固定钢板治疗掌指骨骨折的疗效观察

Application of two types of multi-angle plate in the treatment of metacarpal and phalangeal fractures： a clinical observation

目的 观察两种多角度固定钢板治疗复杂掌指骨骨折的临床效果.方法 2010年1月至2012年9月,我科应用两种多角度固定钢板（翼形和梯形）行内固定治疗58例66处复杂性掌指骨骨折,比较两组骨折愈合时间和术后功能恢复情况.结果 术后随访4～ 18个月,X线片显示骨折愈合时间：采用翼形钢板组为9～ 15周,平均12.3周;梯形钢板组为9～13周,平均11.2周.两者差异有统计学意义.按手指关节总活动度（TAM）法评分：翼形钢板组,优14处、良12处、可3处、差2处,优良率达到83.87％;梯形钢板组,优18处、良14处、可2处、差1处,优良率为91.43％.两者差异有统计学意义.结论 多角度固定钢板对复杂掌指骨骨折固定效果确切,术后早期辅以功能锻炼能达到较满意疗效.

Objective To evaluate the clinical efficacy of two types of multi-angle plates in treating comminuted metacarpal and phalangeal fractures.Methods From January 2010 to September 2012,58 patients with 66 mild comminuted metacarpal or phalangeal fractures were treated with internal fixation using two types of multi-angle plate （wing-shaped and ladder-shaped）.Bone union time and postoperative functional recovery were compared between the two groups.Results All the cases were follow-up for 4 to 18 months.X-ray evidence of fracture healing was seen between 9 and 15 weeks （average,12.3 weeks） postoperatively in the wing-shaped plate group,and between 9 and 13 weeks （average,11.2 weeks） in the ladder-shaped plate group.The difference was statistically significant.Based on total active motion evaluation system the results in the wingshaped plate group were excellent in 14 fractures,good in 12 fractures,fair in 3 fractures,and poor in 2 fractures.The results in the ladder-shaped plate group were excellent in 18 fractures,good in 14 fractures,fair in 2 fractures and poor in 1 fracture.The overall satisfactory rate was 83.87％ in the former and 91.43％ in the latter,the difference being statistically significant.Conclusion The multi-angle plates can achieve accurate fixation of mild comminuted metacarpal and phalangeal fractures,which allows early postoperative functional exercise that leads to satisfactory functional outcomes.