闭合复位双克氏针经基底髓内交叉固定治疗近节指骨关节外骨折

Closed reduction and crossing fixation of extra-articular proximal phalanx fractures using two K-wires via the base

目的探讨双克氏针经基底髓内交叉固定治疗近节指骨关节外骨折的效果。方法回顾性分析2016年5月—2018年5月哈尔滨市第五医院骨科收治的22例(23指)近节指骨关节外骨折患者,男性18例,女性4例;年龄18~50岁,平均35.4岁。致伤原因:摔伤5例,暴力扭伤5例,压砸伤4例,击打伤8例。伤指分布:示指9指,中指6指,环指3指,小指5指。伤后至手术时间1~4d,平均2.3d。均臂丛麻醉下行闭合复位双克氏针经基底交叉固定治疗,术后复查手指正侧位X线片,术后第2天在专业康复师指导下开始功能练习,术后每4周复查手指正侧位X线片。统计分析手术时间、骨折愈合时间、患指掌指关节活动度,患指屈伸活动按照手指总主动活动度(total active motion,TAM)评价。结果手术时间30~42min,平均38.6min;术后无针道感染、克氏针变形、断裂发生。患者均获4~9个月门诊随访,平均5.7个月;骨折临床愈合时间(8.95±3.38)周;拔除克氏针后1周,患指掌指关节活动度为81°~89°,平均87.5°;TAM为243°~278°,平均265.4°,均为优。结论采用闭合复位双克氏针经基底髓内交叉固定治疗近节指骨关节外闭合骨折,手术操作简单、损伤小、固定可靠,患指可早期功能练习,预后好。

Objective To investigate the effect of intramedullary fixation via the phalanx base using two crossing K-wires in the treatment of extra-articular fractures of the proximal phalanges.Methods Retrospective analysis on 22 patients(23 fingers)with extra-articular fractures of proximal phalanges treated in the Department of Orthopaedics of the Fifth Hospital of Harbin from May 2016 to May 2018 were conducted,including 18 males and 4females aged from 18 to 50 years,mean 35.4 years.The injury mechanisms were fall injury in 5 cases,violent sprain injury in 5 cases,crush injury in 4 cases and blow injury in 8 cases;while the injured fingers included index finger in 9 cases,middle finger in 6 cases,ring finger in 3 cases and little finger in 5 cases.The time from injury to operation was 1-4 days,2.3 days on average.All fractures underwent closed reduction and crossing fixation using two Kwires via the phalangeal base,under brachial plexus anesthesia.The postero-anterior and lateral X-ray films of the affected fingers were rechecked immediately and every 4 weeks after operation.Functional exercises were started under the guidance of professional rehabilitation physicians on the second day after surgery.The operation time,fracture healing time and range of motion of the metacarpophalangeal joint of the affected finger were statistically analyzed.The flexion and extension activities of the affected fingers were evaluated according to the total active motion.Results The operation time was 30-42 min,mean 38.6 min.There was no infection or deformation/breakage of the K-wires after operation.All cases were followed up for 4-9 months,mean 5.7 months.The clinical healing time of fractures was(8. 95 ± 3. 38)weeks. One week after removal of the K-wires,the range of motion of the metacarpophalangeal joint was 81°-89°,mean 87.5°;and the total active motion was 243°-278°,mean 265.4°,all were excellent.Conclusion The treatment of proximal phalangeal extra-articular fractures with closed reduction and crossing fixation using two K-wires via the phalangeal base has the advantages of simple operation,minimal invasion and reliable fixation.The affected fingers can start functional exercises early to achieve a good prognosis.