闭合复位克氏针与切开复位抽出钢丝内固定治疗骨性锤状指Ⅰb、Ⅱb型的比较研究

Comparison of Close Reduction Kirschner Wire Fixation and Pull-out Steel Wire in the Treatment of Type Ⅰ b and Type Ⅱ b Bony Mallet Ringers

目的：比较闭合复位克氏针与切开复位抽出钢丝内固定治疗骨性锤状指的临床疗效。方法：2010年3月-2013年8月共治疗46例Ⅰb、Ⅱb型骨性锤状指患者,采用闭合复位克氏针内固定治疗23例,应用2枚克氏针固定撕脱骨折块于远节指骨,并应用1枚克氏针固定远指间关节于中立位;采用切开复位抽出钢丝法治疗23例。研究项目包括手术时间、骨折愈合时间、Crawford优良率评价及并发症。结果：术后随访时间为6~12个月。闭合复位克氏针内固定组手术时间及骨折愈合时间明显短于抽出钢丝组,比较差异有统计学意义（P〈0.05）;但两组Crawford优良率评价差异无统计学意义。克氏针组并发症少于抽出钢丝组。结论：骨性锤状指Ⅰb、Ⅱb型治疗时,应用闭合复位克氏针内固定比切开复位抽出钢丝内固定手术操作简单,手术时间短,骨折愈合快,骨折固定牢固且并发症少。

Objective： To compare differences in the clinical results of close reduction and fixation with Kirschner wire and pull-out steel wire in the treatment of type I b and type lib bony mallet finger. Method： From March 2010 to August 2013, 46 patients with type Ⅰ b and type Ⅱb bony mallet finger were treated. Among them, 23 cases underwent close reduction and fixation with Kirschner wires, and the fracture fragment were fixed by using two small Kirschner wires and the distal interphalangeal joint maintained in neutral position with a transarticular Kirschner wire. The other 23 cases were treated by pull-out steel wires. The length of the surgery, fracture healing time, Crawford＇ s score, and complications was compared between the two groups. Result： Patients in both groups had 6 to 12 months of postoperative follow-up. The surgery time and the fracture healing time was shorter in close reduction and Kirsehner wire fixation group than that in the pull-out steel wire group, the difference was statistically significant （ P〈0.05 ） . No statistically significant difference in the Crawford＇ s score was found among the two operative methods. However, there were fewer complications in close reduction and Kirschner wire fixation group than in the pull-out wire group. Conditsion： Close reduction and Kirschner wire fixation of the fracture fragment is a more effective treatment method for type Ib and type lib bony mallet fingers. It is an easier and shorter operation, provides shorter fracture healing time, provides firm fixation, and has fewer complications.