动态牵引支架结合有限内固定与克氏针内固定治疗近指间关节Pilon骨折的病例对照研究

Case control study on therapeutic effects of dynamic external fixtor combined with limited internal fixation and cross K wires fixation for the treatment of Pilon fractures of the proximal interphalangeal joint

目的 :比较动态牵引支架结合有限内固定与克氏针交叉内固定治疗近指间关节Pilon骨折的临床疗效及安全性。方法:自2012年6月至2014年6月,采用动态牵引支架结合有限内固定与克氏针交叉内固定两种手术方案治疗闭合近指间关节Pilon骨折41例45指,全部获得随访。动态牵引支架结合有限内固定组(A组)21例22指,男12例,女9例;平均年龄(30.6±5.6)岁。克氏针交叉内固定组(B组)20例23指,男11例,女9例;平均年龄(30.1±5.3)岁。定期复查X线片,评定关节主动活动范围、骨折愈合时间、感染率及术后关节活动疼痛等指标。结果 :根据中华医学会手外科学会上肢部分功能评定试用标准评定,A组功能评定优良19例,B组13例,A组优于B组(Z=2.558,P=0.011)。骨折平均愈合时间A组(7.9±2.1)周,B组(8.1±2.3)周,两组差异无统计学意义(t=-0.304,P=0.762)。A组感染5指,B组1指,A组感染率高于B组(χ2=3.287,P<0.05)。术后关节活动疼痛VAS评分A组0.18±0.50,B组0.65±0.88,A组关节疼痛低于B组(t=-2.207,P<0.05)。结论 :动态牵引支架结合有限内固定治疗近指间关节Pilon骨折方法可靠,能有效固定骨折,进行早期功能锻炼,恢复关节功能。

Objective：To compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint. Methods：From June 2012 to June 2014,totally 41 patients（45 fingers） with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K wires fixation,and all the patients were followed up.In the dynamic external fixtor combined with limited internal fixation group（group A）,there were 21 patients with 22 fingers,including 12 males and 9 females,with an average of（30.6±5.6） years old. In the cross K wires fixation group（group B）,there were 20 patients with 23 fingers,including 11 males and 9 females,with an average of（30.1±5.3） years old. Regular re examination of X ray was performed to evaluate the active range of joint motion,fracture healing time,infection rate and postoperative joint motion pain. Results：According to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association,the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences（Z=2.558,P=0.011）. The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was（7.9±2.1） weeks,and（8.1±2.3） weeks for group B. There was no significant difference on the mean healing time（t=-0.304,P=0.762）. The infection fingers of group A was 5,and 1 for group B. The difference between the results was statistically significant（χ2=3.287,P〈0.05）. The infection rate of group A was higher than that of group B. The postoperative joint motion pain was evaluated by VAS score,the mean score was 0.18±0.50 in group A,and 0.65±0.88 in group B. The difference between the results was statistically significant（t=-2.207,P〈0.05）. The postoperative joint motion pain was lower than that of group B. Conclusion：Dynamic external fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.