半钩骨移植结合伸肌腱松解治疗陈旧性中节指骨掌侧基底骨折合并近指间关节脱位的临床经验

Treatment of chronic proximal interphalangeal joint fracture and dislocation with hemi-hamate arthroplasty and extensor release

目的探讨采用半钩骨移植结合伸肌腱松解治疗陈旧性中节指骨掌侧基底骨折合并近指间关节(PIPJ)脱位的可行性及临床疗效。方法自2015年5月至2019年7月,笔者对7例陈旧性中节指骨掌侧基底骨折脱位的患者(4例来自北京积水潭医院,3例来自北京朝阳中西医结合急诊抢救中心)进行回顾性研究,所有患者均采取先行伸指肌腱松解,根据中节指骨基底关节面缺损大小,切取半钩骨移植,钢板内固定的方法进行治疗。术后从疼痛、患指近指间关节主动活动范围和骨折愈合时间等方面进行随访,数据比较采用配对样本t检验。结果术后所有患者均获得随访,随访时间为5~12个月,平均(7.4±2.3)个月,伤口均Ⅰ期愈合。术后患者骨折达到X线愈合标准的时间为(2.7±0.7)个月,6例病例关节面平整。术前、术后3个月疼痛视觉模拟评分(VAS)分别为(4.3±1.1)分和(0.9±0.7)分,术前和术后3个月PIPJ的主动ROM分别为(35.7±11.3)°和(83.6±14.6)°,两者比较差异均有统计学意义(P<0.01)。患指PIPJ主动伸直受限(7.1±10.7)°。结论充分的伸指肌腱松解可以在很大程度上有利于陈旧中节指骨掌侧骨折合并PIPJ脱位患者的术中复位,并有利于其术后早期全ROM的功能锻炼,可以考虑与半钩骨移植术联合应用。

Objective To explore the feasibility and clinical efficacy of treatment of chronic proximal interphalangeal joint(PIPJ)fracture and dislocation with hemi-hamate arthroplasty and extensor release.Methods A retrospective study of 7 patients with old metacarpal base fracture and dislocation of the middle phalanx(4 cases from Beijing Jishuitan Hospital and 3 cases from Beijing Chaoyang Integrative Medicine Emergency Medical Center)was conducted.According to the size of the defect of the articular surface of the middle phalangeal bone,the semi-uncinate bone was cut and transplanted and fixed with steel plate according to the size of the defect of the articular surface of the middle phalangeal bone.Postoperative follow-up and statistics were carried out from the aspects of pain,active range of motion of the affected finger proximal interphalangeal joint and fracture healing time,and the main points of intraoperative operation and clinical effect were analyzed and discussed.The data was analyzed by paired sample t test.Results The average follow-up was(7.4±2.3)months.After operation,the wound all primarily healed.All fractures healed with a smooth joint surface with an average of(2.7±0.7)months.The patients were encouraged to begin active ROM exercises after 2 days postoperatively.The visual analog scale values before and after the operation were(4.3±1.1)points and(0.9±0.7)points.The pre-and post-operational active ROM was(35.7±11.3)°and(83.6±14.6)°.Both the differences were statistically significant(P<0.01).There was only slightly active extension limit with(7.1±10.7)°.Conclusion Sufficient extensor release is greatly beneficial not only to the intraoperative reduction of the PIPJ but also to the postoperative ROM exercises.It can be one of the best choices to combined with the hemi-hamate arthroplasty for the chronic PIPJ fracture and dislocation.