手术治疗与短指支具保守治疗腱性闭合性锤状指疗效比较的回顾性研究

Retrospective study for clinical efficacy comparison of operative treatment and conservative treatment by short finger brace for closed tendinous mallet finger

目的探讨比较手术治疗与短指支具保守治疗腱性闭合性锤状指的疗效。方法自2014年10月至2016年12月,我们共收治104例腱性闭合性锤状指患者,其中54例行手术治疗(A组),50例行短指支具固定保守治疗(B组)。所有患者均进行临床随访,记录患指主动活动范围、疼痛、并发症等情况,按Abouna和Brown功能评定标准评定疗效,统计分析两组的疗效差异。结果术后A组随访时间为5~12个月,平均6.3个月;B组随访时间为4-14个月,平均7.1个月。按Abouna和Brown功能评定标准:A组优30例,良15例,差9例,优良率为83.3%;B组优28例,良16例,差6例,优良率为88.0%。两组优良率比较,差异无统计学意义;两组疼痛度比较,差异无统计学意义(P>0.05).A组手术操作复杂,出现伤口感染、异物反应、甲床畸形等并发症;B组治疗后仅1例出现皮肤轻微压疮,正确护理后恢复正常。结论采用短指支具保守治疗腱性闭合性锤状指临床疗效与手术治疗无明显差异,但具有操作简便、费用低廉、并发症少等优点。

Objective To compare the clinical efficacy of operative treatment and conservative treatment by short finger brace for closed tendinous mallet finger. Methods From October 2014 to December 2016, 104 patients with closed tendinous mallet finger were treated. Among them, 54 patients underwent operative treatment (group A) and 50 patients underwent conservative treatment by short finger brace (group B). All the patients were followed up clinically. The active range of motion, pain and complications of affected fingers were recorded. The clinical efficacy was evaluated according to Aboxma and Brown functional evaluation criteria. The difference of clinical efficacy between the two groups was statistically analyzed. Results The follow-up time of group A was 5 to 12 months with an average of 6.3 months, while that of group B was 4 to 14 months with an average of 7.1 months. According to Abouna and Brown functional evaluation criteria, the results were rated as excellent in 30 cases, good in 15 cases, poor in 9 cases with the excellent and good rate being 83.3% in group A;while the results were rated as excellent in 28 cases, good in 16 cases, poor in 6 cases with the excellent and good rate being 88.0% in group B. There was no significant difference in the excellent and good rate between the two groups, and there was no significant difference in the degree of pain between the two groups (P>0.05). The operation of group A was complicated with complications such as wound infection, foreign body reaction, nail bed defbnnity and so on. In group B, only one case had slight pressure sore after treatment, which returned to nonnal after proper nursing. Conclusion The clinical efficacy of conservative treatment by short finger brace for closed tendinous mallet finger is not significantly different from that of operative treatment. However, the conservative treatment has the advantages of simple operation, low cost and fewer complications.