改良动力性外固定牵引支架治疗中节指骨基底关节内骨折

Modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx

目的探讨改良动力性外固定牵引支架治疗中节指骨基底关节内骨折的临床疗效。方法自2015年3月至2018年2月我科应用闭合复位、自制改良动力性外固定牵引支架治疗中节指骨基底骨折患者22例,其中中节指骨基底粉碎性骨折5例,掌侧缘骨折17例。末次随访测量关节活动度和手部握力。结果所有患者均获得骨性愈合,术后即可进行屈伸锻炼,指间关节屈伸良好。无钉道感染,无疼痛和关节僵硬。22例患者术后随访8~20个月,平均11.5个月。采用手指总主动活动度(TAM)评分系统评估:优16例,良5例,中1例。结论改良动力性外固定牵引支架治疗中节指骨基底关节内骨折,固定可靠,不破坏骨折端血运及软组织,有利于骨折愈合,外固定支架结构简单,无需固定关节,可早期进行指间关节屈伸功能锻炼,有利于尽早恢复手部功能。

Objective To explore the clinical efficacy of modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx. Methods From March 2015 to February 2018, 22 patients with fractures of the base of the middle phalanx were treated with close reduction and self-made modified dynamic external fixator traction. Among them, 5 patients suffered from comminuted fracture of the base of the middle phalanx, and 17 patients suffered from palmar edge fractures. The joint mobility and hand grip were measured at the last follow-up. Results All the patients achieved bony union. The flexion and extension exercises were performed after operation, and the flexion and extension of interphalangeal joints were good. No nail infection, pain and joint stiffiiess occurred. All the patients were follow-up from 8 to 20 months with an average 11.5 months. According to the total active motion (IAM) score system, the results were rated as excellent in 16 cases, good in 5 cases and fair in 1 case. Conclusion The modified dynamic external fixator traction is reliable in the treatment of intra-articular fractures of the base of the middle phalanx. It does not destroy the blood supply and soft tissue at the fracture end. It is conducive to fracture healing. The external fixator has simple structure and does not need to fix joints. It can exercise flexion and extension function of interphalangeal joint in early stage, and is conducive to restoring hand function as soon as possible.