微型锚钉环绕法结合中节指骨克氏针内固定治疗近指间关节Ⅱ、Ⅲ型掌板损伤

Clinical analysis of mini anchor wrap method combined with middle phalangeal Kirschner wire internal fixation in the treatment ofⅡand typeⅢvolar plate injury of proximal interphalangeal joint

目的探讨锚钉环绕法结合中节指骨克氏针内固定修复掌侧稳定结构治疗近指间关节Ⅱ、Ⅲ型掌板损伤的疗效.方法自2018年1月至2021年10月,我们共收治37例40指闭合性近指间关节Ⅱ、Ⅲ型掌板损伤的患者,用克氏针固定中节指骨基底骨折,两枚微型锚钉环绕法修复掌板来复位,稳定近指间关节,不固定近指间关节下进行术后早期系统性关节活动康复锻炼,12周后随访指体功能恢复情况,评价临床疗效.结果术后伤口均Ⅰ期愈合,随访时间为6~14个月,平均为10个月.骨折愈合时间为6~8周,平均7周.无一例发生骨髓炎及骨折畸形愈合,关节功能恢复良好,按TAM标准评定手功能:优24例,良9例,差4例,优良率为89.2%.结论微型锚钉环绕法结合中节指骨克氏针内固定修复掌侧稳定结构治疗近指间关节Ⅱ、Ⅲ型掌板损伤,能有效固定骨折及关节脱位,在不固定近指间关节下能早期进行手指关节功能康复锻炼,术后指间关节功能恢复良好.

Objective To investigate the clinical efficacy of mini anchor wrap method combined with middle phalangeal Kirschner wire internal fixation in the treatment ofⅡand typeⅢtype volar plate injury of proximal interphalangeal joint.Methods From January 2018 to October 2021,37 patients(40 fingers)with closedⅡand typeⅢtype volar plate injury of proximal interphalangeal joint were treated.The middle phalanx base fracture was fixed with Kirschner wire,and the volar plate was repaired with two mini anchors to stabilize the proximal interphalangeal joint.The early postoperative systematic joint activity rehabilitation exercise was carried out without fixing the proximal interphalangeal joint.The finger function recovery was followed up 12 weeks later to evaluate the clinical efficacy.Results All the wounds achieved primary healing after operation.The followup time was 6 to 14 months,with an average of 10 months.The healing time of fracture was 6 to 8 weeks,with an average of 7 weeks.No case of osteomyelitis and malunion of fracture occurred,and the joint function recovered well.According to the TAM standard,the hand function was excellent in 24 cases,good in 9 cases,and poor in 4 cases.The excellent and good rate was 89.2%.Conclusion The treatment of I and II type volar plate injury of proximal interphalangeal joint with mini anchor wrap method combined with middle phalangeal Kirschner wire internal fixation can effectively fix fractures and joint dislocation,and early rehabilitation exercise of finger joint function can be carried out without fixation of proximal interphalangeal joint.The function of interphalangeal joint can be recovered well after operation.