经皮克氏针交叉固定治疗近中节指骨骨折

Percutaneous Kirsecher wire cross fixation to treat proximal and middle digital fracture

目的 探讨闭合复位经皮克氏针交叉固定治疗近节、中节指骨骨折的方法和疗效.方法 2008年1月-2014年7月,在手提式X线机透视下闭合复位,经皮顺行或逆行穿入直径0.8-1.2 mm克氏针交叉固定治疗近节、中节指骨骨折231例252处.术后指导患者早期功能锻炼,通过X线片观察骨折愈合情况.结果 术后226例246处获得随访,5例6处失访,随访时间为6-18个月,平均11个月.术后8例10处发生针道感染,5例5处出现克氏针松动,无克氏针断裂.2例2处骨延迟愈合,3例4处骨不愈合,余骨折均Ⅰ期愈合,时间为3-8周.关节活动功能良好,按手指总主动活动度（TAM）系统评定法评定患指功能：优197处,良36处,可9处,差4处,总优良率达92.4%.结论 指骨骨折采用交叉克氏针内固定,可以获得较好的临床疗效,是一种安全、微创有效的治疗方法.

Objective To discuss the method and clinical effect of closed reduction and percutaneous K-wire cross fixation on proximal and middle digital fracture. Methods From January 2008 to July 2014, 231 cases of 252 proximal and middle digital fracture were closed reducted under the examination of handle x-rey, fixed antegrade or retrograde by cross k-wire. Inducted the patients to rehabilitate early after operation. Observed the osteal healing condition through x-ray. Results 226 cases and 246 fractures were followed up. 5 cases and 6 fractures were not followed up, the followed up time was 6-18 months, with the average of 11 months. 8 cases and 10 fracutres had infection in needle tunnel, 5cases and 5 fractures had needle loose, had no needle rupture. Delayed osteal healing occurred in 2 cases and 2 fractures, nonunion occurred in 3 cases and 4 fractures. Other fractures healed primarily, the time ranged from 3 to 8 weeks. The joint motion function was good, according to TAM （total automotion） system criteria the digital function was evaluated, excellent in 197 fractures, good in 36 fractures, fair in 9 fractures, poor in 4 fractures, total excellent and good rate reached to 92.4%. Conclusion Fixing digital fracture by K-wire can obtain good clinical effect, it is a safe, effective and microinvasive therapy.