改良克氏针内固定治疗掌指骨骨折的临床疗效

Minimally invasive open reduction and modified internal fixation with kirschner wires for fracture of metacarpal bones and phalanx bones

目的 研究采用闭合复位或小切口切开复位，改良克氏针内固定治疗掌骨、指骨骨折的临床疗效。方法2010年5月-2013年3月，本组共67例患者。其中掌骨骨折32例．采用小切口切开复位或闭合复位，改良克氏针冠状位交叉内固定治疗。近节指骨骨折35例58指，采用清创复位或小切口切开复位。根据骨折部位．改良克氏针出针点，交叉内固定治疗。术后5d行手指主、被动屈伸功能锻炼。结果67例创面I期愈合，骨折均解剖复位，随访6～24个月，平均15个月，骨折愈合时间4～10周，平均7周；按中华医学会手外科学会TAM评价标准评定，掌骨骨折：优26例，良5例，可1例，优良率96．8％；近节指骨骨折：优23例，良8例，可4例．优良率88．5％。结论采用闭合复位或小切口切开复位联合改良克氏针交叉内固定治疗掌骨、近节指骨骨折，骨折均能解剖复位，且固定可靠，利于早期功能锻炼；手术操作简单，创伤小，无需二次手术，花费少，临床疗效满意。

Objective To investigate the clinical effects of minimally invasive open reduction and modified internal fixation with kirschner wires for repairation fracture of metacarpal bones and phalanx bones. Methods From May 2010 to March 2013, 32 cases with fracture of metacarpal bones, repaired by minimally invasive open reduction and coronary axis cross fixation with kirschner wires. 35 cases with fracture of Nearly section phalanx bones, including 20 cases with single fracture, 9 cases with two fractures, 4 cases with three fractures and 2 case with four fractures, including 12 cases with nearly a third segment, 21 cases with middle a third segment and 10 cases with far a third segment far, including 22 cases with open fractures and 13 cases with closed fractures, after debridement or small incision open reduction, according to the fracture site, were repaired by cross internal fixation with kirschner wires through modified needle point. Fingers began to functional exercises 5 days later. Results All incision healed in one stage and fractures were anatomical repaired. Patients were followed up from 6 to 24 months and the fracture healing time ranged from 4 to 10 weeks. According to the TAM score, metacarpal bones, 26 cases were excellent, 5 cases were good, 1 case was fair, and the excellent and good rate was 96.8%, phalanx bones, 23 cases were excellent, 8 cases were good, 4 cases were fair, and the excellent and good rate was 88.5%. Conclusion Minimally invasive open reduction and modified internal fixation with kirschner wires could repair fracture of metacarpal bones and phalanxbones. With the characteristics of little damage, anatomical reduction, rigid fixation, good function and less cost, the clinical effects were satisfied.