闭合复位克氏针横行固定及切开复位交叉克氏针固定在 掌骨颈骨折中的应用效果比较

Comparison of application effects of closed reduction and Kirschner wire transverse fixation and open reduction and cross Kirschner wire fixation in metacarpal neck fracture

目的比较闭合复位克氏针横行固定及切开复位交叉克氏针固定在掌骨颈骨折中的应用效果。方法以我院2015年1月至2020年1月收治的80例第5掌骨颈骨折患者为研究对象,根据抽签法随机将其分为A组和B组,各40例。A组采取切开复位交叉克氏针固定,B组采取闭合复位克氏针横行固定,术后随访12个月,比较两组术中及术后相关资料(手术时间、骨折痊愈时间、末次随访时握力和掌指关节活动度);评估术前、术后7 d及1、3个月的疼痛程度;比较术后手指关节总主动活动度(TAM)优良率及掌骨颈干角(健侧颈干角、患指术后颈干角、患指痊愈后颈干角)度数;记录并发症发生情况。结果B组手术时间显著短于A组(P<0.05);两组骨折痊愈时间、末次随访握力及掌指关节活动度无显著差异(P>0.05)。重复测量方差分析结果显示,两组VAS评分的时点、时点×组间交互效应比较,差异具有统计学意义(P<0.05),而组间效应比较,差异无统计学意义(P>0.05)。两组的手指关节TAM优良率比较,差异无统计学意义(P>0.05)。两组的健侧颈干角、患指术后颈干角、患指痊愈后颈干角度数比较,差异无统计学意义(P>0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论闭合复位克氏针横行固定及切开复位交叉克氏针固定用于掌骨颈骨折中的疗效均较好,但闭合复位克氏针横行固定的手术时间相对较短,值得临床推广应用。

Objective To compare the application effects of closed reduction and Kirschner wire transverse fixation and open reduction and cross Kirschner wire fixation in metacarpal neck fracture.Methods A total of 80 patients with the fifth metacarpal neck fracture admitted in our hospital from January 2015 to January 2020 were selected as the study objects and randomly divided into group A and group B by lottery method,with 40 cases in each group.The group A was treated with open reduction and cross Kirschner wire fixation,and the group B was treated with closed reduction and Kirschner wire transverse fixation.The patients were followed up for 12 months,the intraoperative and postoperative related data(operation time,fracture healing time,grip strength and range of motion of metacarpophalangeal joint at the last follow-up)were compared between the two groups;the degree of pain before and at 7 d,1 and 3 months after operation were evaluated;the excellent and good rate of total active movement(TAM)of finger joint and the degree of metacarpal head shaft angle(contralateral head shaft angle,postoperative head shaft angle of affected finger,head shaft angle of affected finger after recovery)after operation were compared;the occurrence of complications were recorded.Results The operation time in the group B was significantly shorter than that in the group A(P<0.05);there were no significant differences in fracture healing time,grip strength and range of motion of metacarpophalangeal joint at the last follow-up between the two groups(P>0.05).The results of repeated measurement ANOVA showed that there were significant difference in interaction effects of time point and time point×inter group of VAS score between the two groups(P<0.05),but there was no significant difference in interaction effect of inter group(P>0.05).There was no significant difference in the excellent and good rate of TAM of finger joint between the two groups(P>0.05).There were no significant differences in contralateral head shaft angle,postoperative head shaft angle of affected finger,head shaft angle of affected finger after recovery between the two groups(P>0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion Closed reduction and Kirschner wire transverse fixation and open reduction and cross Kirschner wire fixation for metacarpal neck fracture both have good curative effect.The operation time of closed reduction and Kirschner wire transverse fixation is relatively shorter,which is worthy of clinical promotion and application.