多指再植可吸收髓内钉与克氏针内固定效果比较研究  

The comparative study of the effects of absorbable intramedullary nails and Kirschner wire on amputated finger replantation

作　　者：秦金桥[1] 黄潮桐[1] 陈隆福[2] 李敬矿[1] 朱家恺[3] 陈冬生[1] 

机构地区：[1]广东医学院附属厚街医院显微外科中心,广东东莞523945 [2]广东医学院2006级骨外科硕士研究生,广东湛江524023 [3]中山大学附属第一医院骨科-显微外科医学部,广州510080

出　　处：《中国临床解剖学杂志》2009年第1期100-102,105,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省医学科研基金立项课题(A2002835)

摘　　要：目的:探讨PDLLA混合壳聚糖可吸收髓内钉与克氏针在多指再植指骨内固定的疗效。方法:2001年9月～2006年5月,对36例102指离断伤进行再植,采用自行研发的PDLLA混合壳聚糖可吸收髓内钉与克氏针对比的原则固定指骨,其中采用髓内钉固定49指,克氏针固定53指,术后对两种固定进行比较。结果:髓内钉固定组:再植成活42指,克氏针组成活44指,成活指伤口愈合良好,髓内钉固定组无皮下积液及窦道形成。而且较克氏针组骨折断端骨痂数量多,密度高,中、后期骨痂质量好,成熟程度高,成活病例进行随访,时间3～10个月,平均4个月。按照中华医学会手外科学会断指再植功能评定试用标准进行比较,经统计分析,髓内钉组疗效优于克氏针组。结论:PDLLA混合壳聚糖可吸收髓内钉在多指再植指骨固定方面较克氏针有明显的优势。Objective： To compare the fracture fixation effects of absorbable intramedullary nails of poly-DL-lactic acid （PDLLA）mixed with chitosan and Kirschner wire on amputated finger replantation. Methods： From September 2001 to May 2006, internal fixation were performed with absorbable intramedullary nails of PDLLA mixed with chitosan （PDLLA＋chitosan group, independent development） and Kirschner wire in 36 cases （102 fingers） of amputated finger （49 fingers were treated with absorbable intramedullary nails and the other 53 with Kirschner wire）. The post-operative effects were compared. Results： 42 fingers fixed with absorbable intmmedullary nails survived, as well 44 fingers with Kirschner wire. The wounds healed with no subcutaneous hydops and sinuses in PDLLA＋chitosan group, while the osteotylus of broken ends formed with more large quantity, high-density and maturity, and good-texture at the intermediate and later stage compared to those of Kirschner wire group. Survived cases were followed up 3 to 10 months, averagely of 4 months. According to the functional evaluation in digital replantation and statistical analysis of Hand Surgery of Chinese Medical Association,it was found that the effects of PDLLA-chitosan group was better than Kirschner wire group. Conclusions： Absorbable intramedullary nails of PDLLA mixed with chitosan has conspicuous advantages in amputated finger replantation, compared to Kirschner wire.

关 键 词：断指再植术 骨折固定术 可吸收材料 髓内钉 

分 类 号：R658.1[医药卫生—外科学]