克氏针和微型钢板内固定治疗不同节段掌指骨骨折疗效比较

Comparison of Efficacies for Different Segments of Metacarpal and Phalangeai Fractures Using Kirschner Wire Versus Mini-Plate Fixation

【目的】比较克氏针和微型钢板内固定治疗不同节段掌指骨骨折临床疗效。【方法】回顾性分析本院2010年2月至2013年9月收治的136例掌指骨骨折患者的临床资料。其中64例（82处）采用克氏针内固定方法（克氏针组），72例（93处）采用微型钢板内固定方法（微型钢板组），分别比较两种治疗方法对不同节段掌指骨骨折的疗效差异。【结果】克氏针组患者的疗效优良率为73．68％，显著低于微型钢板组的95．65％（P〈0．05）。针对不同节段掌指骨骨折，克氏针组近节指骨折患者的疗效优良率为81．48％，低于微型钢板组的87．50％，但二者差异无显著性（P〉o．05）；克氏针组中节指骨折患者的疗效优良率为86．11％，显著的高于微型钢板组的63．16％（P〈0．05）。克氏针组患者掌骨骨折和近节指骨折愈合时间[（7．6±0．4）周和（7．8±0．5）周]显著高于微型钢板组患者[（6．1±0．5）周和（6．8±0．5）周]，差异有统计学意义（P〈0．05），但两者中节指骨骨折的骨折愈合时间差异无显著性（P〉0．05）。两组患者的术后感染、骨延迟愈合率差异也无显著性（P〉0．05）。【结论】微型钢板内固定法适合治疗掌骨骨折，克氏针法适合治疗中节指骨骨折，两种方法对近节指骨折的治疗效果相近，但采用微型钢板内固定法可以缩短其骨折愈合时间。

[Objective] To compare the clinical efficacies of internal fixation with Kirschner wire versus mini-plate for different segments of metacarpal fracture. [Methods] From February 2010 to Septemher 2013, the clinical data of 136 patient with metacarpal fracture were retrospectively collected. They were divided into two groups of Kirschner wire （ n 64） and mini-plate （ n = 72）. Their efficacies were compared. [Results] The good rate in Kirschner wire group was significantly lower than that in mini-plate group （73.68% vs 95.65%, P〈0.05） ; the good rate was higher in mini-plate group than that in Kirschner wire group in the treatment of proximal phalanx fracture （87.50 % vs 81.48 % ）. However, the difference was insignificant （ P 〉0.05）. The good rate was higher in Kirschner group than that in micro-plate group in the treatment of middle phalanx （86.11% vs 63.16 %, P〈0.05）. The mini-plate group was significantly lower than the Kirschner wire with regards to healing times of metacarpal and proximal phalanx fractures [ （7.6 ±0.4） vs （6. 1±0.5） weeks, （7.8±0.5） vs （6.8±0.5） weeks, P〈0.05]. Phalanx fracture healing time, postoperative infection or delayed bone healing rate had no significant inter-group difference （ P 〉0.05）. [Conclusion] Mini-plate internal fixation is superior in the treatment of metacarpal fractures while Kirschner wire fares better for middle phalanx. And two treatments are similarly efficacious for proximal phalanx fracture.