掌骨和指骨骨折治疗后致手指屈曲畸形原因分析  

Flexion Deformity after Operation for Metacarpal and Phalangeal Fractures

作　　者：纪柳[1] 李庆泰[1] 刘沐青[1] 于志军[1] 梁波[1] 

机构地区：[1]清华大学玉泉医院手外科,北京100049

出　　处：《科技导报》2009年第18期104-105,共2页Science & Technology Review

摘　　要：为分析掌骨、指骨骨折治疗后出现手指屈曲畸形的原因,于2003年1月至2007年12月,采用克氏针固定治疗掌骨和指骨骨折128例,其中掌骨骨折25例、近节指骨骨折37例,中节指骨骨折42例,混合性骨折24例。病例中,闭合性骨折38例,开放性骨折90例,均采用不贯穿关节交叉克氏针和斜行克氏针固定骨折,外固定均采用石膏包裹,其中指间关节屈曲位固定者53例,伸直位固定者75例,石膏固定3～4周。克氏针固定时间4～15周。随访3～8个月,出现近侧指间关节屈曲畸形,活动受限19例(15%)。结果显示,克氏针治疗掌骨和指骨骨折时常因躲避克氏针而采用屈曲手指位外固定,导致伸指肌腱主纤维带松弛位粘连,必然造成伸指时无力或不能伸展;再由于克氏针的贯穿造成韧带损伤,克氏针本身对指背筋膜的损伤都可能导致关节屈曲畸形。To study the flexion deformity after surgical treatment for metacarpal and phalangeal fractures,from January 2003 to December 2007,128 outpatients suffered from metacarpal and phalangeal fractures were chosen in this paper.All of the fractures were fixed with Kirschner wires.Among them,25 cases are of metacarpal fractures,37 cases of proximal phalanx fractures,42 cases of middle phalanx fractures,and 24 cases of multiple fractures.All of the fractures,of which 38 cases of closed fractures and 90 cases of open fractures,were fixed with cross or oblique Kirschner wires.All the Kirschner wires did not go through the joints.After the operation,plasters were used for 3 to 4 weeks,53 of which in flexion position and 75 in extension position.The Kirschner wires were taken out 4 to 15 weeks after the operation.The results show that 19 cases of proximal interphalangeal joint flexion deformity were found（15%）.The Flexion position is usually used in Kirschner wire fixation of metacarpal,phalangeal fractures to avoid the skin stimulation of the tail of Kirschner wire.The damage of the dorsal fascia might be responsible to flexion deformity.

关 键 词：掌骨骨折 指骨骨折 克氏针固定 指背腱膜结构 损伤 

分 类 号：R687.3[医药卫生—骨科学]