双克氏针指骨基底进针髓内固定治疗近节指骨骨折

Double Kirschner wire via phalangeal base insertion for intrarnedullary fixation of proximal phalangeal fractures

目的探讨双克氏针于指骨基底进针髓内固定技术治疗近节指骨骨折的临床效果。方法自2013年9月至2014年6月，对25例30指除拇指外的近节指骨骨折患者，采用闭合复位克氏针于指骨基底处经皮进针行髓内固定方法进行治疗，术后在康复医师指导下即刻开始功能锻炼，合并神经或肌腱损伤者术后支具固定3周开始功能锻炼。结果术后全部患者获得6～11个月的随访，平均8．3个月，全部骨折均顺利愈合，愈后外观无明显成角和旋转畸形，克氏针无断裂、无松脱，按手指关节总活动度（TAM）系统评价标准评定：优13指，良12指，可4指，差1指；优良率为83．3％。结论双克氏针指骨基底进针髓内固定治疗近节指骨骨折，可选用更粗的克氏针获得更好的稳定性，有助于早期功能锻炼，减少肌腱粘连及关节僵硬，并能简化操作过程，降低操作难度。

Objective To evaluate the clinical results of treating proximal phalangeal fractures with double Kirschner wire intramedullary fixation inserted through the phalangeal base. Methods From September 2013 to June 2014, 25 cases with 30 proximal phalangeal fractures of the fingers were treated by intramedullary fixation with double Kirschner wires that were inserted through the side of the phalangeal base. Functional exercise started immediately after the surgery in patients with fracture fixation only, and 3 weeks postoperatively in patients with combined tendon or nerve repair. Results All the patients were follow-up for 6 to 11 months, with an average of 8.3 months. All the fractures healed uneventfully. There were no obvious angular or rotational deformities. There were no Kirschner wire breakage or loosening. Rated by the total active range of motion （TAM） system, functions were excellent in 13 fingers, good in 12 fingers, fair in 4 fingers and poor in 1 finger, with an overall satisfactory rate of 83.3%. Conclusion Double Kirschner wire intramedullary fixation via phalangeal base insertion can be used to treat proximal phalangeal fractures when thicker Kirschner wires are chosen to achieve better fixation stability and allow early postoperative exercise that reduces tendon adhesion and joint stiffness. This can simplify the operation procedure and reduce technical difficulties of the surgery.