有无骨片的Ⅰ型锤状指手术后疗效的比较分析  

A comparative study of the trealrnent outcomes of type I mallet fingers with or without an avulsed fracture fragment

作　　者：钱忠卫 顾剑辉[1] 邓爱东[1] 顾晓坤[1] 

机构地区：[1]南通大学附属医院手外科,江苏226001

出　　处：《中华手外科杂志》2011年第5期291-293,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨有骨片和无骨片的Ⅰ型锤状指手术疗效的差异。方法2005年至2010年，收治46例Ⅰ型锤状指患者，其中A组22例，为伸肌腱止点处有撕脱骨折，术中采用克氏针固定远指问关节和撕脱骨片；B组24例，为单纯伸肌腱止点处断裂，不伴撕脱骨折，术中采用克氏针固定远指间关节，根据肌腱断裂情况选择缝合方法。两组均在术后5。7周拔除克氏针。结果术后两组随访时间为5—38个月，平均16个月。依据Patel标准评价结果：A组优7例，良5例，中3例，差7例；B组优7例，良3例，中10例，差4例。A组中功能评分为差的比例占31．8％，多于B组差的比例16．7％，但B组中功能仅恢复到中的患者占41．7％。两组优良率的差异无统计学意义（P〉0．05）。结论有远节指骨基底部撕脱骨片的锤状指功能差的患者是无撕脱骨片患者的近2倍，无骨片的锤状指功能为中的比例较大（41．7％），但两组疗效基本相同。Objective To analyze the treatment outcomes of type I mallet fingers with or without bony fragment. Methods From 2005 to 2010, 46 patients with type I mallet fingers were treated. They were divided into two groups. In group A, 22 patients had type I mallet fingers with madsion fractmrc at the extensor insertion. The distal interphalangeai joint and the avulsed bone fragment were fLxed with K-wires. In group B, 24 patients had type I mallet fingers without a fracture. The distal interphalangeal joint was fixed with a K-wire, and the ruptured tendon was sutured. The K-wire was removed after 5 to 7 weeks in both groups. Results All patients in both groups were follow-up for 5 to 38 months, with an average of 16 months. According to Patel＇ s evaluation standard, there were 7 eases graded as excellent, 5 eases as good, 3 cases as fair, and 7 eases as poor in group A; there were 7 cases as excellent, 3 cases as good, 10 cases as fair, and 4 cases as poor in group B. The percentage of poor function in group A was 31.8%, higher than the percentage of poor function in group B which was 16. ＂/%. However, fair function in group B accounted for 41. ＂/%. There were no significant differences in excellent rates between two groups （ P 〉 0.05）. Conclusion Poor treatment outcomes in patients of type I mallet fingers with distal phalanx base avulsion fracture is almost twice as much as in patients of type I mallet fingers without avulsion fracture fragments. Fair functional outcomes in patients without avulsion bone fragnents accounted for 41.7%. The overall results were similar between the two groups.

关 键 词：骨折 腱损伤 随访研究 锤状指 

分 类 号：R687.3[医药卫生—骨科学]