经骨折块固定及克氏针扣压法固定治疗骨性锤状指的临床研究

Clinical study of direct fixation and pressing fixation of fracture fragments with Kirschner wire for treatment of bony mallet finger

目的探讨骨性锤状指治疗方法与效果。方法自2011年3月至2016年2月，我们共收治48例骨性锤状指患者。根据Wehbe和Schneider分型：ⅠA型20例，ⅠB型12例，ⅠC型9例，ⅡA型5例，ⅡB型2例。其中ⅠA及ⅡA型骨折采用骨折块克氏针扣压法固定，ⅠB、ⅠC及ⅡB型骨折采用经骨折块克氏针直接固定。结果本组48例术后均获得随访，时间为6～22个月，平均14个月，伤口Ⅰ期愈合，患指远指间（DIP）关节伸屈活动度为0°～70° 19例，0°-60°24例，-6°～60°4例，-15°～60°1例。均为骨性愈合，骨折愈合时间为1～2个月，平均1．5个月。根据Crawford锤状指疗效评定标准：优43例，良4例，可1例，优良率为97．9％。结论根据不同类型骨性锤状指，采用适合骨折类型的内固定方式，能降低术后并发症的发生率，提高临床疗效。

Objective To investigate the treatment method and curative effect of bony mallet finger. Methods From March 2011 to February 2016, 48 cases of bony mallet finger were treated. According to the Wehbe and Schneider classification, type Ⅰ A was in 20 cases, type Ⅰ B in 12 cases, type Ⅰ C in 9 cases, type Ⅱ A in 5 cases, type ⅡB in 2 cases. The cases of type Ⅰ A and type Ⅱ A were treated by pressing fixation of fracture fragments with Kirschner wire, while the cases of type Ⅰ B, Ⅰ C and Ⅱ B were treated by direct fixation of fracture fragments with Kirschner wire. Results All the 48 patients were follow-up for 6 to 22 months, with an average of 14 months. All the incisions healed by first intention. The range of motion （ROM） of DIP joint was 0° to 70° in 19 cases, 0° to 60° in 24 cases, -6° to 60° in 4 cases and -15° to 60° in 1 case. Bone union was achieved in all cases with a mean period of 1.5 months （range, 1 to 2 months）. The treatment outcomes were evaluated by the Crawford rating scale, which were graded as excellent in 43 cases, good in 4 cases and fair in 1 case. The overall excellent and good rate was 97.9%. Conclusion According to different types of bony mallet finger, application of appropriate internal fixations in the treatment can reduce the incidence of postoperative complications and improve the clinical efficacy.