改良双克氏针加压固定治疗骨性锤状指疗效及其影响因素分析

The curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers and its influencing factors

目的探索改良双克氏针加压固定治疗骨性锤状指疗效,并分析影响疗效的相关因素。方法回顾性分析2018年1月至2020年12月济宁医学院附属医院兖州院区100例采用改良双克氏针加压固定治疗的骨性锤状指患者的临床资料。分别于术前和术后8周评估Fugl-Meyer评分、简易手功能检查(STEF)评分、疼痛视觉模拟评分(VAS),并测量指关节屈曲活动度。采用Crawford标准评定疗效,优秀+良好为预后良好,中等+较差为预后较差。采用二元Logistic回归分析影响骨性锤状指患者疗效的因素;相关性采用Spearman法。结果患者术后14 d切口均Ⅰ期愈合,手部功能和结构恢复良好,无相关切口皮肤坏死和针道感染发生。患者术后8周Fugl-Meyer评分、STEF评分和指关节屈曲活动度明显高于术前[(62.58±4.56)分比(32.33±2.84)分、(91.31±3.19)分比(62.51±3.42)分和(66.72±3.65)°比(45.56±2.31)°],VAS明显低于术前[(2.65±1.19)分比(5.68±1.43)分],差异有统计学意义(P<0.01)。根据Crawford标准,预后良好79例,预后较差21例。预后良好与预后较差患者性别构成、受伤位置、致伤原因、受损类型比较差异无统计学意义(P>0.05);与预后较差患者比较,预后良好患者年龄低,受伤至手术时间短,受伤部位以小指和环指为主,差异有统计学意义(P<0.05或<0.01)。二元Logistic回归分析结果显示,年龄、受伤至手术时间和受伤部位是影响骨性锤状指患者疗效较差的独立危险因素(OR=4.62、5.94和2.33,95%CI 1.06~20.14、2.23~15.81和1.12~4.82,P<0.05或<0.01)。Spearman相关分析结果显示,疗效与年龄、受伤至手术时间和受伤部位呈正相关性(r=0.25、0.62和0.43,P<0.05或<0.01)。结论改良双克氏针加压固定治疗骨性锤状指患者可促使术后指功能恢复,但年龄、受损部位和就诊时间是影响疗效的独立危险因素。

Objective To explore the curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers,and analyze the related influencing factors of curative effect.Methods The clinical data of 100 patients with skeletal mallet fingers from January 2018 to December 2020 in Yanzhou Branch of Affiliated Hospital of Jining Medical University were retrospectively analyzed,and the patients were treated with modified double Kirschner wire compression fixation.Before surgery and 8 weeks after surgery,the Fugl-Meyer score,simple test for evaluating hand function(STEF)score and visual analogue score(VAS)were assessed,and the flexion range of knuckles was measured.The curative effect was evaluated by Crawford standard,excellent and good means was good prognosis,medium and poor was poor prognosis.Binary Logistic regression was used to analyze the influencing factors of curative effect in patients with skeletal mallet fingers,Spearman method was used to analyze correlation.Results All incisions healed in the first stage 14 d after surgery,the function and structure of the hand recovered well,and related incision skin necrosis and needle tract infection did not occur.Compared with before surgery,the Fugl-Meyer score,STEF score and flexion range of knuckles 8 weeks after surgery were significantly higher:(62.58±4.56)scores vs.(32.33±2.84)scores,(91.31±3.19)scores vs.(62.51±3.42)scores and(66.72±3.65)°vs.(45.56±2.31)°,the VAS was significantly lower:(2.65±1.19)scores vs.(5.68±1.43)scores,and there were statistical differences(P<0.01).According to Crawford standard,good prognosis was in 79 cases,and poor prognosis was in 21 cases.There were no statistical differences in gender composition,injury location,cause of injury and type of injury between good prognosis patients and poor prognosis patients(P>0.05);compared with the poor prognosis patients,the good prognosis patients were younger,the time from injury to surgery was shorter,the injured parts were mainly the little finger and ring finger,and there were statistical differences(P<0.05 or<0.01).Binary Logistic regression analysis result showed that age,time from injury to operation and injury site were independent risk factors of curative effect in patients with skeletal mallet fingers(OR=4.62,5.94 and 2.33;95%CI 1.06 to 20.14,2.23 to 15.81 and 1.12 to 4.82;P<0.05 or<0.01).Spearman correlation analysis result showed that the curative effect was positively correlated with age,time from injury to operation and injury location(r=0.25,0.62 and 0.43;P<0.05 or<0.01).Conclusions Modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers can promote the recovery of finger function after surgery,but age,damaged location and time of visit are independent risk factors of curative effect.