微型外固定辅助内固定对指关节开放性骨折术后功能康复的效果

Effect of mini external fixation and internal fixation on functional rehabilitation of open fractures of knuckles

目的探讨指关节开放性粉碎骨折患者采用微型外固定辅助克氏针内固定治疗对指关节功能恢复的价值。方法前瞻性分析2015年4月—2018年10月哈尔滨医科大学附属第四医院骨科采用克氏针实施内固定治疗的指关节开放性粉碎骨折患者121例,随机数字表分为两组。联合组(克氏针内固定+微型外固定支架)61例,男性33例,女性28例;年龄24~65岁,平均39.8岁;左侧35例,右侧26例。克氏针组(克氏针内固定)60例,男性36例,女性24例;年龄19~64岁,平均38.5岁;左侧31例,右侧29例。观察比较两组患者的骨折愈合时间、术后关节可活动时间、手术并发症、手术指关节的主动活动范围(AROM)、被动活动范围(PROM)、功能恢复情况。结果联合组患者的骨折愈合时间(8.51±1.36)周、术后关节可活动时间(4.70±0.86)周均早于克氏针组(9.25±1.52)周、(5.11±0.88)周,差异有统计学意义(P<0.05);联合组患者的手术并发症发生率11.48%低于克氏针组的26.67%,差异有统计学意义(P<0.05);术后8、16周时,联合组患者的AROM(160.6±31.1)°、(222.5±36.4)°、PROM(176.6±41.0)°、(232.9±43.5)°均大于克氏针组AROM(146.2±28.1)°、(209.5±33.0)°;PROM(158.8±36.3)°、(217.0±39.2)°,差异有统计学意义(P<0.05);术后16周时,联合组患者的手术指关节功能优于克氏针组,差异有统计学意义(P<0.05)。结论指关节开放性粉碎骨折患者采用微型外固定辅助克氏针内固定治疗更有利于指关节功能早期锻炼及术后康复。

Objective To explore the value of micro external fixation assisted Kirschner wire internal fixation for the recovery of knuckle function in patients with open comminuted fracture of the knuckle.Methods A prospective study was performed on 121 patients with open comminuted fractures of the knuckles that were intended to be internally treated with Kirschner wires in the Department of Orthopaedics of the Fourth Affiliated Hospital of Harbin Medical University from Apr.2015 to Oct.2018.They were divided into two groups.In the combined(Kirschner wire internal fixation+micro external fixator)group,there were 61 cases(33 males and 28 females),aged 24-65 years(mean 39.8 years),35 cases on the left side and 26 cases on the right side.In the Kirschner wire group(Kirschner wire fixation),there were 36 males and 24 females with an average age of 38.5 years(range,19-64 years),31 cases on the left side and 29 cases on the right side.The fracture healing time,postoperative joint mobility time,surgical complications,active range of motion(AROM),passive range of motion(PROM),and functional recovery of the surgical knuckles were observed in the two groups of patients.Results The fracture healing time(8.51±1.36)weeks,postoperative joint mobility time(4.70±0.86)weeks of the combined group were earlier than the control group[(9.25±1.52)weeks,(5.11±0.88)weeks],and the differences were statistically significant(P<0.05).The surgical complication rate in the combination group was 11.48%,lower than that in the control group(26.67%),and the difference was statistically significant(P<0.05);At 8 weeks and 16 weeks after surgery,the AROM[(160.6±31.1)°,(222.5±36.4)°],and PROM[(176.6±41.0)°,(232.9±43.5)°]of the combined group were higher than those of the control group[AROM:(146.2±28.1)°,(209.5±33.0)°;PROM:(158.8±36.3)°,(217.0±39.2)°],and the differences were statistically significant(P<0.05).At 16 weeks after operation,there was a statistically significant difference in surgical knuckle function between the combined group and the control group(P<0.05),and the combined group was better than the control group.Conclusion Micro external fixator assisted with Kirschner wire internal fixation for patients with open comminuted fractures of the knuckles is more conducive for early exercise of knuckle function and postoperative rehabilitation.