微型外固定支架联合克氏针内固定微创治疗闭合性近节指骨骨折

Mini external fixation support combined kirschner wire treated closed section near phalanx fractures with minimally invasive surgery

目的探讨微创条件下,应用微型外固定支架联合克氏针内固定治疗闭合性近节指骨骨折的方法和疗效。方法 2011年5月至2015年7月,应用微型外固定支架联合克氏针内固定治疗闭合性近节指骨骨折24例,其中男21例,女3例;年龄18～56岁,平均27.2岁。骨折部位：单纯近节指骨骨折18例,掌骨、近节指骨复合骨折6例,所有病例均行皮肤小切口,最大程度保留手部外观的完整。结果术后平均6周骨折愈合。其中2例发生针孔处皮肤轻度感染,但未影响最终治疗。术后无瘢痕形成,外观满意。按中华医学会手外科学会上肢部分功能评定试用标准评定患指运动功能：优22例,良1例,可1例;优良率95.83%。结论在微创手术条件下,应用微型外固定支架联合克氏针内固定治疗闭合性近节指骨骨折,能有效固定骨折,早期进行功能锻炼,避免掌指关节僵硬挛缩,恢复患指功能,最大程度减少瘢痕形成。

Objective To explore minimally invasive surgery in the clinical application of hand fracture and the clinical outcome of mini- external fixator combined with kirschner wire internal flxation for Closed proximal phalanx fractures with minimally invasive surgery. Methods From May 2011 to July 2015,24 patients（ 21 males and 3females） with closed proximal phalanx fractures were treated with mini- external fixator combined with kirschner wire internal flxation. The patients＇ age ranged from 18 to 56 years,with an average of 27. 2 years. There were18 cases of proximal phalanx fractures,6 cases of both metacarpal and proximal phalanx fractures. Kirschner wire combinedwith mini- external fixator,did not cut the skin,was used in all the cases for flaxtion. Results All the fractures healed 6 weeks postoperatively. Mild pin track infection occurred in 2 cases,all of which did not affect the outcome. After operation,all of cases were with satisfied appearance and no cicatrization. The upper limb functional evaluation criteria issued by the Chinese Hand Surgery Society was used to assess the motion function of the injured fingers and rate the overall results,which were excellent in 24 cases,good in 22 cases,fair in 1 cases and poor in 1 cases respectively. The overall good- excellent rate was 95. 83%. Conclusion Minimally invasive surgery which mini- external fixator combined with kirschner wire internal flxation for Closed proximal phalanx fractures could effectively enhance fracture fixation,which benefited to early postoperative functional rehabilitation,recovery of wounded finger function and reduced scar.