骨性锤状指伴远端指间关节掌侧滑脱患者的手术治疗

Surgical treatment of the mallet fracture with distal interphalangeal joint palmar subluxation

目的探讨骨性锤状指伴发远端指间关节掌侧滑脱病例的治疗方案。方法对34例骨性锤状指伴发远端指间关节掌侧滑脱的患者,根据骨折块累及关节面的比例、骨折块厚度,分别采用闭合复位石黑法固定或切开复位单枚克氏针固定’结果依据骨性锤状指新的分型,Ila型9例,lib型15例,III型10例,Ila型均采用闭合复位石黑法内固定;lib型中7例采用闭合复位石黑法固定,8例行切开复位单枚克氏针内固定;III型均行切开复位单枚克氏针固定。34例获10〜19个月随访,平均(14.4±1.9)个月;骨折愈合时间5~9周,平均(6.6±1.2)周。闭合复位石黑法固定组,术后远端指间关节屈曲(64.1±6.9)°,背伸受限(6.3±4.7)°;切开复位单枚克氏针固定组,术后远端指间关节屈曲(62.8±8.6)°,背伸受限(7.5±4.3)%两组之间远端指间关节屈曲活动度差异无统计学意义(t=0.476,P=0.637),伸直活动度差异无统计学意义(t=-0.815,P=0.421)o结论依据骨折块累及关节面范围和骨折块厚度的骨性锤状指分型,选择不同术式和克氏针固定的方法,手术操作简单,效果满意。

Objective To discuss the surgical treatment of mallet fracture with distal interphalangeal joint palmar subluxation.Methods According to the involvement of the joint surface and the thickness of the fragment in the fracture,34 cases of mallet fracture with distal interphalangeal joint palmar subluxation were fixed by closed reduction and Ishiguro fixation,or by open reduction and single Kirschner wire fixation.Results There were 9 cases of type Ila,15 cases of type Illb and 10 cases of type III according to the new classification of mallet fracture.Closed reduction and Ishiguro fixation were used in type Ila and 7 type lib patients;Open reduction and Kirschner wire fixation were used in type III and 8 type lib patients.All patients were followed up for 10-19 months with an average of(14.4±1.9)months.Fracture healing ranged 5-9 weeks with an average of(6.6±1.2)weeks.Flexion and extension of the distal interphalangeal joint postoperatively:(64.1±6.9)°,(6.3±4.7)°,respectively in the closed reduction group;(62.8±8.6)°,(7.5±4.3)°,respectively in the open reduction and Kirschner wire fixation group;no significant differences were observed between the two groups(t=0.476,P=0.637;t=-0.815,P=0.421).Conclusions Individualized surgery based on involvement of the joint surface and the thickness of the fragment in the fracture is recommended to achieve satisfactory results.