两种空心拉力螺钉内固定法治疗近节指骨横形骨折的疗效对比

Comparison of two kinds of hollow lag screw internal fixation in the treatment of transverse fracture of proximal phalanx

目的对比两种空心拉力螺钉内固定法治疗近节指骨横形骨折的疗效。方法自2017年8月至2018年11月我科共诊治46例近节指骨横形骨折患者,其中20例采用纵行空心拉力螺钉法(A组)治疗,26例采用斜行空心拉力螺钉法(B组)治疗。比较两组患者的随访时间、指间关节活动度、掌指关节活动度、术后并发症情况及功能评定结果结果术后A组患者随访时间为18〜24个月,平均20.8个月;B组患者随访时间为19~24个月,平均20.3个月,两组随访时间比较差异无统计学意义(P>0.05)。A、B两组指间关节活动度分别为(76.5±6.6)。和(82.2±2.4)°,A组小于B组且差异有统计学意义。A、B两组掌指关节活动度分别为(73.5±11.7)°和(73.4±11.9)°,两组差异无统计学意义两组骨折均顺利愈合,未出现内固定断裂、伤口不愈合、骨不连及骨折畸形愈合等并发症。按中华医学会手外科学会上肢部分功能评定标准,A组优良率为80.0%,B组为84.6%,B组高于A组。结论与纵行空心拉力螺钉法相比,斜行空心拉力螺钉治疗近节指骨横形骨折的疗效更佳。

Objective To compare the efficacy of two kinds of hollow lag screw internal fixation in the treatment of proximal phalanx transverse fracture.Methods From August 2017 to November 2018,46 patients with transverse fracture of proximal phalanx were treated in our department.20 cases were treated with longitudinal hollow lag screw(group A),and 26 cases were treated with oblique hollow lag screw(group B).The follow-up time,range of motion of interphalangeal joint,range of motion of metacarpophalangeal joint,postoperative complications and functional evaluation results were compared between the two groups.Results The follow-up time of group A was 18 to 24 months,with an average of 20.8 months;the follow-up time of group B was 19 to 24 months,with an average of 20.3 months.There was no significant difference in the follow-up time between the two groups(>0.05).A.The range of motion of interphalangeal joint was(76.5±6.6)°in group A and(82.2±2.4)°in group B.Group A was less than group B,and the difference was statistically significant.The range of motion of metacarpophalangeal joint was(73.5±11.7)°in group A and(73.4±11.9)°in group B.There was no significant difference between the two groups.The fractures of the two groups achieved primary healing.There were no complications such as fracture of internal fixation,wound nonunion,bony nonunion and malunion.According to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association,the excellent and good rate of group A was 80.0%,and that of group B was 84.6%,which was higher than that of group A.Conclusion Compared with longitudinal hollow lag screw,oblique hollow lag screw is more effective in the treatment of transverse fractures of proximal phalanx.