动力性外固定架和手部支具治疗中节指骨基底部掌侧缘骨折疗效比较

Comparison of the clinical curative effect between dynamic external fixator and hand orthosis in patients with middle phalanx pars basilaris fracture

目的比较动力性外固定架（DEF）和手部支具（HO）治疗中节指骨基底部掌侧缘骨折的临床疗效。方法连续选取2015年1月至2016年4月收治的单指中节指骨基底部掌侧缘骨折患者143例，根据患者的选择进行分组，其中DEF组83例，HO组60例。DEF组患者在指根局部神经阻滞麻醉下行DEF固定治疗，HO组患者手法复位满意后采用HO固定治疗。观察两组骨折愈合时间和并发症发生情况；患者经过功能锻炼后，采用手指总活动度（TAM）标准评价手功能恢复情况。结果两组患者随访8～16周，平均12周。DEF组和HO组骨折愈合时间比较差异无统计学意义（P〉0.05）。两组患者术后均出现不同程度的疼痛，但在拆除DEF或HO后，DEF组术后疼痛发生率明显低于HO组[26.51%（22/83）比46.67%（28/60）]，差异有统计学意义（P〈0.05）。两组患者拆除外固定后均未出现再次脱位或半脱位。随访X线检查显示，DEF组轻度创伤性骨关节炎、轻度成角畸形和轻度侧方不稳定发生率均明显低于HO组[6.02%（5/83）比23.33%（14/60）、3.61%（3/83）比33.33%（20/60）和1.20%（1/83）比26.67%（16/60）]，差异有统计学意义（P〈0.05）。DEF组TAM优良率明显高于HO组[83.13%（69/83）比63.33%（38/60）]，差异有统计学意义（χ^2= 7.25，P〈0.01）。结论利用DEF治疗中节指骨基底部掌侧缘骨折优于HO。

ObjectiveTo discuss the clinical curative effect between dynamic external fixator （DEF） and hand orthosis （HO） in patients with middle phalanx pars basilaris fracture.MethodsA total of 143 patients with middle phalanx pars basilaris fracture were selected from January 2015 to April 2016. The patients were divided into 2 groups according to the patients′ select： DEF group （83 cases） and HO group （60 cases）. The patients in DEF group were treated with DEF fixation under local nerve block anesthesia of digital root, and the patients in HO group were treated with HO fixation after manual repositioning. The fracture healing time and complications were observed. All patients were functionally trained and evaluated by total active motion （TAM）.ResultsThe patients were followed up for 8 to 16 weeks, with an average of 12 weeks. There was no statistical difference in fracture healing time between 2 groups （P〉0.05）. All patients had postoperative pain, but the incidence of postoperative pain after removing DEF or HO in DEF group was significantly lower than that in HO group： 26.51% （22/83） vs. 46.67% （28/60）, and there was statistical difference （P〈0.05）. No redislocation or subluxation occurred after removal of external fixation in 2 groups. X-ray follow-up showed that the incidences of mild traumatic osteoarthritis, mild angulation deformity and mild lateral instability in DEF group were significantly lower than those in HO group： 6.02% （5/83） vs. 23.33% （14/60）, 3.61% （3/83） vs. 33.33% （20/60） and 1.20% （1/83） vs. 26.67% （16/60）, and there were statistical differences （P〈0.05）. The excellent and good rate of TAM in DEF group was significantly higher than that in HO group： 83.13%（69/83） vs. 63.33% （38/60）, and there was statistical difference （χ^2= 7.25, P〈0.01）.ConclusionsThe clinical curative effect of DEF fixation is better than HO fixation in patients with middle phalanx pars basilaris fracture.