改良缝线锚钉缝合修复近侧指间关节掌板损伤

Modified suturing with anchor for repair of volar plate injury of proximal interphalangeal joint

[目的]介绍骨锚结合改良缝合法修复近指间关节掌板撕脱骨折的手术技术与初步临床疗效。[方法] 2017年5月~2019年4月,本科收治的近指间关节掌板撕脱骨折患者10例10指,所有患者均使用骨锚结合改良缝合法加压捆绑固定中节基底掌侧撕脱骨块。术后4周拆除外固定铝板,术后6~8周,待骨折线消失后,拔除克氏针,指导康复锻炼。[结果] 10例患者伤口均I期愈合,随访12~15个月,平均(12.90±0.94)个月。术后影像显示所有骨折均达到解剖复位。依据中华医学会手外科分会上肢功能(total active movement, TAM)系统评分标准,优8例,良2例,优良率100.00%。[结论]骨锚结合改良缝合法治疗掌板撕脱骨折,骨折块固定确切牢靠,符合关节内骨折解剖重建原则。

[Objective] To introduce the surgical technique and preliminary clinical outcomes of the modified suturing with anchor for volar plate avulsion fracture of proximal interphalangeal joint of the finger. [Methods] From May 2017 to April 2019, 10 patients(10 fingers) with avulsion fracture of proximal interphalangeal joint were surgically treated in our hospital. After reduction and temporary tansarticular fixation with a K-wire, all fractures were firmly fixed, while the volar plate repaired with modified suturing by anchor. After the operation, the injured finger was fixed with an aluminum plate for 4 weeks. The K-wire was removed as the fracture line disappeared at 6-8 weeks after operation. The active flexion and extension excises of the proximal interphalangeal joint was conducted under guide of the rehabilitator. [Results] All the 10 patients had the incisions healed primarily, and were followed up from 12~15 months with a mean of(12.90±0.94) months. The postoperative radiology revealed that all fractures got anatomic reduction. According to criteria of Chinese Hand Surgery Society, Chinese Medical Association in term of total active motion(TAM) system, the clinical outcomes were graded as excellent in 8 cases, good in 2 cases, with excellent and good rate of 100.00%(10/10). [Conclusion] The modified suturing with anchor is a good method for the treatment of volar plate avulsion fracture, which does secure the fracture fragments firmly and meet to principles of anatomical reconstruction.