改良加压石黑法治疗骨性锤状指的临床研究

EFFECTIVENESS OF MODIFIED Ishiguro TECHNIQUE WITH STRENGTHENING PRESSURE IN TREATMENT OF BONY MALLET FINGERS

目的通过与经典石黑法比较,探讨改良加压石黑法治疗骨性锤状指的临床疗效。方法回顾分析2013年5月-2015年5月手术治疗的31例骨性锤状指患者临床资料,其中16例采用经典石黑法（对照组）,15例采用改良加压石黑法（固定远指间关节和阻挡撕脱骨折块的2枚克氏针远端用皮筋捆绑,起到持续弹性加压作用）。两组患者性别、年龄、致伤原因、损伤指别、受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。结果术后对照组2例、改良组1例切口延迟愈合,其余患者切口均Ⅰ期愈合。患者均获随访,改良组随访时间为8-23个月,平均11个月;对照组为9-24个月,平均12个月。对照组术后1个月内2例克氏针弯曲变形,骨折块与远节指骨分离明显,手法复位后重新支具固定,经随访出现远指间关节炎;其余患者骨折均愈合,愈合时间为（6.8±0.8）周。改良组骨折均顺利愈合,愈合时间为（5.7±1.5）周;未发生克氏针变形、骨折移位或断端分离。两组骨折愈合时间比较差异有统计学意义（t=—2.439,P=0.021）。末次随访时,根据Crawford评定标准,对照组优9例、良4例、可2例、差1例,优良率为81.25%;改良组优10例、良3例、可2例,优良率为86.67%;两组比较差异无统计学意义（Z=—0.636,P=0.525）。结论与经典石黑法相比,改良加压石黑法对骨折间能起到持续弹性加压作用,促进骨折愈合,减少术后克氏针变形及松动,降低手术失败率,减少术后创伤性关节炎等并发症的发生,可有效治疗骨性锤状指。

Objective To investigate the effectiveness of modified Ishiguro technique with strengthening pressure in the treatment of bony mallet finger by comparing with the traditional Ishiguro technique. Methods Between May 2013 and May 2015, 31 cases of bony mallet finger were treated with traditional Ishiguro technique in 16 cases（control group） and with modified Ishiguro technique in 15 cases（improved group, the two Kirschner wires were bound, which were used to fix the distal interphalangeal joint and blocking avulsion fracture block in the classical Ishiguro technique, and play a continuous elastic compression）. Difference was not significant in gender, age, cause of injury, injury finger, and the time from injury to operation between 2 groups（P〉0.05）. Results The wound healing was delayed in 2 cases of the control group and 1 case of the improved group, and the other patients obtained healing by first intension. The follow-up time was 8-23 months（mean, 11 months） in the improved group and was 9-24 months（mean, 12 months） in the control group. Bending deformation of the Kirschner wire occurred in 2 cases of the control group, obvious separation was found between fracture fragment and the distal phalanx; after manual reduction, brace was used to fix, and distal interphalangeal arthritis occurred during follow-up. The fracture healing time was（6.8±0.8） weeks in the control group, and was（5.7±1.5） weeks in the improved group. There was significant difference in the healing time between 2 groups（t= —2.439, P=0.021）. At last follow-up, according to Crawford criteria, the results were excellent in 9 cases, good in 4 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 81.25% in the control group; the results were excellent in 10 cases, good in 3 cases, and fair in 2 case with an excellent and good rate of 86.67% in the improved group. There was no significant difference in excellent and good rate between 2 groups（Z= —0.636, P=0.525）. Conclusion Compared with traditional Ishiguro technique, the modified Ishiguro technique with strengthening pressure in treatment of bony mallet finger can facilitate the fracture healing, reduce Kirschner wire loosening and deformation, and decrease the rates of operation failure and complications.