经骨隧道钢丝捆扎治疗骨性锤状指

Treatment of bony mallet finger with steel wire binding through bone tunnel

目的 评价经远节指骨骨隧道钢丝捆扎治疗骨性锤状指的临床疗效。方法 选取2019年8月至2022年7月安徽医科大学第一附属医院显微手足修复重建病区收治的骨性锤状指患者32例,根据治疗方法将其分为两组:观察组(15例)采用经骨隧道钢丝捆扎法治疗,对照组(17例)采用微型骨锚钉法治疗。记录手术时间和治疗费用,观察切口愈合及并发症情况。采用Crawford标准评价术后功能恢复情况。结果 32例患者均顺利完成手术,观察组手术时间短于对照组[(57.5±18.1)min vs (69.6±15.3)min],治疗费用少于对照组[(6 936.25±639.78)元vs(11 021.62±459.73)元],差异均有统计学意义(P均<0.05)。术后随访3~24个月,平均(15.9±7.0)个月。术后3个月采用Crawford标准评价功能恢复情况,观察组优良率为100.0%(15/15),对照组优良率为82.4%(14/17),两组差异无统计学意义(P>0.05)。观察组患者手术切口均一期愈合,未出现切口感染、皮肤坏死、骨折块移位、关节畸形等并发症;对照组有3例术后切口恢复较差(2例出现线结反应),1例发生骨折畸形愈合,1例发生甲板畸形。结论 经骨隧道钢丝捆扎治疗骨性锤状指手术操作简单,患者远指间关节功能恢复满意,是一种较理想的治疗方法。

Objective To evaluate the clinical effect of the treatment of bony mallet finger with steel wire binding through bone tunnel of the distal phalanx.Methods From Aug.2019 to Jul.2022,32 patients with bony mallet fingers who were admitted to the hand and foot micro repair and reconstruction ward of The First Affiliated Hospital of Anhui Medical University were selected and divided into 2 groups according to the different treatment methods.The observation group(15 cases)used the steel wire binding method through bone tunnel,and the control group(17 cases)used the micro bone anchor method.The operation time,treatment cost,wound healing and complications were recorded.The Crawford criteria was used to evaluate the postoperative functional recovery.Results All 32 patients successfully completed the operation.The operation time in the observation group was significantly shorter than that in the control group([57.5±18.1]min vs[69.6±15.3]min,P<0.05),and the treatment cost was significantly lower than that in the control group([6936.25±639.78]yuan vs[11021.62±459.73]yuan,P<0.05).The patients were followed up for 3 to 24 months,with an average of(15.9±7.0)months.According to the Crawford criteria the excellent and good rate was 100.0%(15/15)in the observation group and 82.4%(14/17)in the control group 3 months after surgery,with no statistical significance(P>0.05).In the observation group,all patients healed at the first stage without wound infection,skin necrosis,displacement of fracture blocks,joint deformities or other complications.In the control group,there were 3 cases with poor postoperative incision recovery(including 2 cases with suture reaction),1 case with fracture malunion,and 1 case with deck deformity.Conclusion The treatment of bony mallet finger with steel wire binding through bone tunnel is an ideal method with simple operation and satisfactory functional recovery of the distal interphalangeal joint.