一期闭合复位双克氏针弹性加压固定治疗Wehbe-SchneiderⅠB型及ⅡB型骨性锤状指

Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires

目的 探讨一期闭合复位双克氏针弹性加压固定治疗Wehbe-SchneiderⅠB、ⅡB型骨性锤状指的疗效。方法 2017年5月—2020年6月,采用一期闭合复位双克氏针弹性加压固定治疗21例Wehbe-SchneiderⅠB、ⅡB型骨性锤状指患者。男15例,女6例;年龄19-62岁,平均39.2岁。致伤原因:运动伤9例,戳伤7例,扭伤5例。受伤至入院时间5-72 h,平均21.0 h。损伤指别:示指2例,中指8例,环指9例,小指2例。远端指间关节(distal interphalangeal joint,DIPJ)主动背伸丧失角度为(40.04±4.02)°。根据Wehbe-Schneider分型标准:ⅠB型10例,ⅡB型11例。术后6周待X线片复查示撕脱骨折达骨性愈合后取出克氏针,并开始患指功能锻炼。结果 手术时间35-55 min,平均43.9 min;住院时间2-5 d,平均3.4 d。术后无相关并发症发生。患者均获随访,随访时间6-12个月,平均8.8个月。X线片复查示撕脱骨折均达骨性愈合,愈合时间4-6周,平均5.3周。术后6周取出克氏针后,DIPJ主动屈曲时疼痛视觉模拟评分(VAS)为1-3分,平均1.6分;被动屈曲至最大活动度时为2-5分,平均3.1分。患指DIPJ主动背伸丧失角度为(2.14±2.54)°,与术前比较差异有统计学意义(t=52.186,P<0.001)。患指DIPJ主动屈曲角度为(79.52±6.31)°,与对应健指(81.90±5.36)°比较,差异无统计学意义(t=1.319,P=0.195)。术后3个月,根据Crawford功能评定标准评价,疗效达优11例、良9例、一般1例,优良率为95.24%。结论 对于Wehbe-SchneiderⅠB、ⅡB型骨性锤状指,一期闭合复位双克氏针弹性加压固定可有效纠正畸形,具有操作简便、手术无切口不影响患指外观等优点。

Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with onestage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years(range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours(mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint(DIPJ) was(40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes(mean, 43.9 minutes). The length of hospital stay was 2-5 days(mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months(mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks(mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale(VAS) score of pain during active flexion of the DIPJ was 1-3(mean, 1.6);the VAS score of pain was2-5(mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was(2.14±2.54)°, showing significant difference when compared with preoperative angle(t=52.186,P<0.001). There was no significant difference in the active flexion angle between the affected finger(79.52±6.31)° and the corresponding healthy finger(81.90±5.36)°(t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. Conclusion For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.