微型外固定支架治疗掌指骨关节内粉碎性骨折

Treatment of comminuted intra-articular fractures of the hand using Orthofix mini-external fixator

目的 探讨应用微型外固定支架治疗手部掌指骨关节内粉碎性骨折的方法和疗效.方法 自2012年7月至2014年4月,我们应用有限克氏针内固定结合微型外固定支架治疗掌指骨关节内粉碎性骨折32例.术后通过X线片观察骨折愈合情况,按照总主动活动度（total active motion,TAM）标准评定手指功能.结果 术后31例获得随访,时间为6～ 13个月,平均10个月.术后无伤口感染、钢针断裂及松动.骨折愈合时间为6～ 13周,平均8.5周.按TAM标准评定手指功能：优15例,良11例,可5例,优良率达83.9％.结论 微型外固定支架治疗掌指骨关节内粉碎性骨折固定可靠,能够维持正常的掌指关节或指间关节间隙,保持关节侧副韧带及关节囊的正常张力,可以早期功能锻炼,是一种较为理想的治疗掌指骨关节内粉碎性骨折的方法.

Objective To explore the technique and outcomes of applying mini external fixator in the treatment of comminuted intra-articular fractures of metacarpal or phalangeal bones.Methods Orthofix miniexternal fixator combined with limited Kirschner wire fixation was used in treating 32 patients with metacarpal or phalangeal comminuted intra-articular fractures between July 2012 and April 2014.Postoperative fracture healing was observed and judged by X-rays.Functions of the involved fingers were evaluated using total active motion （TAM）.Results Thirty-one patients were available for follow-up evaluation.The follow-up period ranged from 6 to 13 months,with a mean of 10 months.The healing time of fracture ranged from 6 to 13 weeks,with a mean of 8.5 weeks.According to TAM criteria,the results were rated as excellent in 15 cases,good in 11 cases,and fair in 5 cases.83.9% of the patients had excellent and good range of motion of the affected fingers.There were no complications such as infection,pin rupture,or pin loosening.Conclusion Mini-external fixator can provide stable fixation for comminuted intra-articular fractures of the hand,sustain the normal joint space and the normal tightness of the ligaments around the joint,and permit early rehabilitation.Mini-external fixator is a good option for the treatment of comminuted intra-articular fractures of the hand.