微型外固定支架联合克氏针治疗开放性粉碎性掌指关节骨折的临床观察

Clinical observation of minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint

目的 ：探讨采用微型外固定支架联合克氏针固定开放性粉碎性掌指关节骨折的方法和疗效。方法 ：自2013年1月至2014年12月,采用微型外固定支架配合克氏针固定治疗13例开放性粉碎性掌指关节骨折患者,其中男9例,女4例;年龄18~56岁,平均35岁。根据开放性骨折Gustilo分型：Ⅱ型8例,ⅢA型4例,ⅢB型1例。受伤至手术时间2~7 h,平均5 h。均累及掌指骨关节面。观察术后骨折愈合时间及术后并发症情况,采用2000年中华医学会手外科学会上肢断肢再植功能评定试用标准（TAM系统）进行功能评价。结果：13例患者均获得随访,时间3~12个月,平均7个月。骨折均达到骨性愈合,愈合时间4~6周,平均（4.6±1.0）周。术后未出现断钉及松动现象,无钉道感染、畸形愈合、支架松动,未见反射性交感神经性营养不良。根据TAM系统,优7例,良4例,可1例,差1例。结论：微型外固定支架联合克氏针固定开放性粉碎性掌指关节骨折,操作简便、稳定性好、可后期调整、对软组织骨膜破坏小、感染率低、可早期行功能锻炼,值得临床推广应用。

Objective：To explore the method and therapeutic effect of minor external fixation combined with Kirschner Treatment for open comminuted fracture of metacarpophalangeal joint. Methods：From January 2013 to December 2014,13 patients with open comminuted fracture of metacarpophalangeal joint were treated by minor external fixation combined with Kirschner wire,including 9 males and 4 females,aged from 18 to 56 years old with an average of 35 years old.According to Gustilo classification,8 cases were typeⅡ,4 cases were type ⅢA,and 1 case was type ⅢB. The time from injury to operation ranged from 2 to 7 h with an average of 5 h. All fractures were involved with metacarpal phalangeal joint surface. Fracture healing time and postoperative complications were observed,TAM scoring system by Hand Surgery Association of Chinese Medical Association was used to evaluate functional recovery. Results：All patients were followed up from 3 to 12 months with an average of 7 months. All fractures were obtained bone healing,and the time ranged from 4 to 6 weeks with an average of（4.6±1.0）weeks. No broken and loose needle,pin track infections,malunion,loose bracket,reflection sexual sense of neurological malnutrition occurred. According to TAM scoring system,7 cases obtained excellent results,4 cases good,1 case moderate and 1case poor. Conclusion：Minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint has advantages of simple operation,good stability and which could be adjusted at the later stage,less damage for soft tissue periosteum,low inflammatory,earlier functional exercise. It is worth to be popularized and applied.