应用交叉克氏针髓内支撑联合钢丝捆扎治疗掌指骨干粉碎型骨折

Crossed Kirschner wire intramedullary support combined with steel wire tying for the treatment of comminuted fractures of metacarpal and phalangeal shaft

目的探讨应用交叉克氏针髓内支撑联合钢丝捆扎治疗掌指骨干粉碎型骨折的手术方法及临床效果.方法自2016年1月至2021年4月,我们应用交叉克氏针髓内支撑联合钢丝捆扎治疗掌指骨干粉碎型骨折患者21例,其中掌骨骨折9例,指骨骨折12例,合并肌腱、血管、神经损伤18例.本组均为骨干粉碎型开放性骨折.术后按照加速康复外科围手术期管理路径指导患者康复.结果本组21例术后伤口均Ⅰ期愈合,术后均获得随访,时间为5~60个月,平均7个月.随访中复查X线片未见内固定断裂,1例出现克氏针松动,1例出现针道轻度感染,经对症处理后治愈,2例出现针头局部皮肤激惹增生.所有骨折均临床愈合,时间为7~12周,平均10周.所有患者均重返工作岗位,时间为4~6个月,平均5个月.按照中华医学会手外科学会上肢部分功能评定试用标准手指关节总活动度(total active motion,TAM)系统评价标准评定,优8例,良10例,可3例.结论应用交叉克氏针髓内支撑联合钢丝捆扎治疗掌指骨干粉碎型骨折可达到解剖复位,且固定牢固,无需跨关节固定,可早期康复锻炼,避免关节僵硬,是一种良好的固定方法.

Objective To explore the method and clinical outcome of crossed Kirschner wire intramedullary support combined with steel wire tying for the treatment of comminuted fractures of metacarpal and phalangeal shaft.Methods From January 2016 to April 2021,21 cases of comminuted fractures of metacarpal and phalangeal shaft were treated by crossed Kirschner wire intramedullary support combined with steel wire tying,including 9 metacarpal fractures,12 phalangeal fractures,and 18 cases with tendon,blood vessel,and nerve injuries.All the fractures were comminuted open fractures of the shaft.After operation,the patients'rehabilitation was guided according to the perioperative management path of enhanced recovery after surgery(ERAS).Results The wounds of 21 patients achieved primary healing.All the patients were followup for 5 to 60 months,with an average of 7 months.During follow-up,no fracture of internal fixator was found on X-ray films.One case had loose Kirschner wire,one case had mild infection of needle path,which was cured after symptomatic treatment,and two cases had local skin irritation and hyperplasia of needle head.All the fractures healed clinically in 7 to 12 weeks,with an average of 10 weeks.All the patients returned to work for 4 to 6 months,with an average of 5 months.According to the system evaluation standard of total active motion(TAM)of upper limb function issued by Hand Surgery Society of the Chinese Medical Association,8 cases were excellent,10 cases were good,and 3 cases were fair.Conclusion The application of crossed Kirschner wire intramedullary support combined with steel wire tying for the treatment of comminuted fractures of metacarpal and phalangeal shaft can achieve anatomical reduction,and the fixation is firm,without cross joint fixation,early rehabilitation exercise and joint stiffness can be avoided,which is a good fixation method.