钢板与克氏针固定Bennett骨折的比较

Comparison of plate versus Kirschner wire for internal fixation of Bennett fracture

[目的]比较切开复位钢板固定与闭合复位经皮克氏针固定治疗Bennett骨折的临床效果。[方法]回顾性分析本院2015年1月—2019年1月手术治疗Bennett骨折52例患者的临床资料。依据术前医患沟通结果,28例采用切开复位钢板固定,24例采用闭合复位经皮克氏针固定。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术。钢板组术中透视次数、恢复主动活动时间显著优于克氏针组(P<0.05),但前者术中失血量显著多于后者(P<0.05)。平均随访时间(18.4±3.6)个月,两组恢复完全负重时间的差异无统计学意义(P>0.05)。随着术后时间推移,两组DASH评分均显著下降(P<0.05),术后3个月钢板组DASH评分显著优于克氏针组(P<0.05),但术后1年两组间的差异无统计学意义(P>0.05)。影像方面,两组骨折对合和第一掌腕对线较术前显著改善(P<0.05),术前两组骨折对合及第一掌腕对线的差异均无统计学意义(P>0.05),但是末次随访时钢板组上述影像指标均显著优于克氏针组(P<0.05)。两组骨折愈合时间差异无统计意义(P>0.05)。[结论]两种术式治疗Bennett骨折均可获得良好疗效,各具优缺点,切开复位钢板固定复位精准,固定牢靠。

[Objective]To compare the clinical outcomes of open reduction and internal fixation(ORIF)with locking plate fixation ver⁃sus closed reduction and percutaneous Kirschner wire fixation of Bennett fracture.[Methods]A retrospective study was performed on 52 patients who received surgical treatment for Bennett fracture in our hospital from January 2015 to January 2019.According to preoperative doctor-patient communication,28 patients had plate used,while the remaining 24 patients had Kirschner wire applied.The data regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]All the patients in both groups had cor⁃responding procedures conducted successfully.The plate group proved significantly superior to the wire group in terms of times of fluorosco⁃py and the time to return active activity(P<0.05),whereas the former got significantly more intraoperative blood loss than the latter(P<0.05).All the patients were followed up for(18.4±3.6)months on an average,with no a significant difference in the time to resume fullweight bearing activity between the two groups(P>0.05).The DASH scores decreased significantly in both groups over time after operation(P<0.05),which were not significantly different between the two groups at 1 year after operation(P>0.05).Radiographically,fracture align⁃ment and first metacarpal alignment in both groups significantly improved postoperatively compared with those preoperatively(P<0.05),which proved not significant between the two groups before operation(P>0.05),whereas the plate group were significantly better than the wire group at the latest follow-up(P<0.05).However,there was no significant difference in fracture healing time between the two groups(P>0.05).[Conclusion]Both plate and wire for fixation are effective treatment of Bennett fracture,with their own advantages and disadvantag⁃es.By comparison,the ORIF with plate is more accurate and reliable than the percutaneous Kirschner wire.