手术复位内固定加动态牵引克氏针外固定架治疗近指间关节内骨折

The clinical application of dynamic external fixator for the proximal interphalangeal joint frature

目的报道一种自制动态牵引克氏针外固定架在治疗近指间关节内骨折的临床应用效果。方法2009年8月-2013年12月，对11例近指间关节内骨折患者，在采用c臂机辅助闭合复位或行切开复位克氏针内固定同时，辅以一种自行设计的动态牵引克氏针外固定支架进行固定。术后早期即拆除石膏托。并指导患者进行患指主动功能康复训练，术后定期复查，待骨折愈合后取出内固定克氏针及外固定支架，并对患指功能进行评价。结果11例患者术后获得13~24个月随访。平均16．7个月。所有患者均未发生骨折不愈合或畸形愈合，无针道感染发生。1例患者术后3周出现外固定架失稳表现，给予拆除后改为指骨夹板继续固定1周。术后功能评价：优7例，良2例，可2例。结论使用动态牵引克氏针外固定支架在治疗近指间关节内粉碎性骨折方面，具有牵引力适中、关节间隙撑开效果显著、并在一定活动范围内可有效维持关节内间隙等优势。

Objective To observe the effectiveness of stable fracture of the proximal interphalangeal joint cember 2013,11 cases with PIP joint fracture. Open a dynamic external fixator for treatment of un- （PIP）. Methods Between August 2009 to Dc- reduction and internal fixation with Kirschner wire at the same time in the use of C arm machine assisted closed reduction or line, supplemented by the use of a dynamic self-designed traction Kirschner wire external fixator fixed, early after op- eration that removed the plaster, and guide the patients to excercise active functional rehabilitation training, follow-up, to be healed removal of internal fixation of Kirschner wire and external fixa- tion fracture, and the risk of evaluation function. Results 11 cases received 13 to 24 months fol- low-up, an average of 16.7 months. All patients had no nunion or malunion of fracture, no pin tract infection. External fixation instabihty occured in 1 patients after 3 weeks, given to the demoh- tion and changed sphnt fixation for 1 week. The postoperative functional evaluation： excellent 7 cases, good 2 cases, fair 2 cases. Conclusion Dynamic external fixator for fracture of the proximal interphalangeal joint, with the traction force is moderate, joint space distraction effect is remarkable, and in certain activities within the scope can effectively maintain the advantages of joint clearance.