两种骨性锤状指手术治疗方法对比分析

Comparative analysis of two surgical methods for bony mallet fingers

目的探讨改良抽出钢丝法和微型骨锚钉治疗骨性锤状指的疗效对比,为临床治疗提供合适的手术方案。方法收集2017年10月~2020年7月Wehbe和Schneider分型中骨性锤状指为Ⅰa亚型和Ⅱa亚型病例,共40例(40指)。随机分成两组,分别应用改良抽出钢丝法和微型骨锚钉法治疗。结果术后随访3~16个月,平均8.3个月。术后两组病例应用Crawford等评定标准进行评价,改良抽出钢丝法组:优8例,良9例,可2例,差1例,优良率85%;微型骨锚钉法:优10例,良6例,可1例,差2例,优良率84.21%,差异无统计学意义(P>0.05)。改良抽出钢丝法组均一期愈合,但1例出现指甲畸形,微型骨锚钉法组2例出现线结反应,取出线结后换药二期愈合,两组均有不同程度并发症的发生,差异无统计学意义(P>0.05)。改良抽出钢丝法组手术时间较长,但手术费用较低,微型骨锚钉法组手术时间较短,手术费用较高,两组比较,差异有统计学差异(P<0.05)。结论应综合考虑患者的意愿、经济条件等选择术式,微型骨锚钉法仍不能完全取代改良抽出钢丝法等传统方法,尤其是在基层医院。

Objective To compare the efficacy of extracting wire method and micro bone anchor method in the treatment of bony mallet fingers,and to provide an appropriate surgical scheme for clinical treatment.Methods From October 2017 to July 2020,40 cases of bony mallet fingers were collected from the classification of Wehbe and Schneider,40 cases(40 fingers in total).The patients were randomly divided into two groups,and treated by extracting wire method and micro bone anchor method,respectively.Results The patients were followed up for 3~16 months(mean 8.3 months).After operation,the two groups were evaluated by Crawford and other evaluation standards.In the extracting wire method group:8 cases were excellent,9 cases were good,2 cases were fair,1 case was poor,and the excellent and good rate was 85%;in the micro bone anchor method group:10 cases were excellent,6 cases were good,1 case was fair,and 2 cases were poor,and the excellent and good rate was 84.21%,P>0.05,without statistical significance.In the extracting wire method group,there was primary healing,but there was 1 case of nail deformity.In the micro bone anchor method group,there were 2 cases of line segment reaction,and the line segment was removed and the dressing was changed for secondary healing.There were different degrees of complications in the two groups,P>0.05,without statistical significance.The extracting wire method group had a longer operative time,but the operative cost was lower,and the micro bone anchor method group had a shorter operative time and higher operative cost,and the difference was statistically significant(P<0.05).Conclusion The choice of surgical methods should be based on the wishes and economic conditions of patients.The micro bone anchor method still can not completely replace the traditional methods such as extracting wire method,especially in primary hospitals.