微型钢板放置指骨背侧与侧方在治疗近节指骨骨折的临床对比  

Comparative study of fixation of proximal phalangeal fractures using mini titanium plates by dorsal and lateral approach

作　　者：于志军 纪柳[2] 李庆泰[2] 刘沐清[2] 秦永平[2] 梁波[2] 

机构地区：[1]玉田县鸦鸿桥中心卫生院,河北玉田064102 [2]清华大学玉泉医院手外科,北京100049

出　　处：《实用手外科杂志》2013年第1期21-23,共3页Journal of Practical Hand Surgery

摘　　要：目的 分析比较微型钢板治疗近节指骨骨折放置指骨背侧与侧方对恢复手功能的临床效果.方法 2009年6月-2011年6月,对62例71指近节指骨骨折患者行切开复位内固定治疗.A组：40例45指近节指骨骨折,切开复位微型钢板固定在指骨背侧；B组：22例26指近节指骨骨折,切开复位微型钢板固定在指骨侧方.术后对骨折愈合时间、并发症及术后手功能恢复情况进行比较分析.结果 术后随访4～24个月,平均11个月.按TAM系统评价法评定：A组优12指,良15指,中12指,差6指；优良率为60％.B组优18指,良6指,中2指,差0指；优良率为92％.两组在骨折愈合时间、感染率上差异无统计学意义.结论 治疗手指近节指骨骨折将微型钢板放置在指骨侧方,肌腱粘连和伸指功能障碍明显减少,手指功能恢复良好；缺点是生物稳定性较放在指骨背侧差.Objective To compare of the effect of hand function recovery of proximal phalanx fractures fixed by mini titanium plate by the dorsal and lateral approach. Methods Totally 62 cases, 7] fingers, with proximal phalanx fractures were included in the study from June 2009 to June 2011. In Group A, 40 cases, 45 fingers, were treated with open reduction and internal fixation by mini titanium plate on the dorsal aspect of the proximal phalanx. In Group B, 22 cases, 26 fingers, were treated with open reduction and internal fixation by mini titanium plate on the lateral aspect of the proximal phalanx. Bone healing time, postoperative complications and finger function were assessed. The clinical results were evaluated by using the total active motion （TAM） criterion of the finger movement. Results All the patients were followed- up for 4 to 24 months, with an average time of ] ] months. According to the TAM evaluation criteria, in group A, excellent results were achieved in 12 fingers, good in 15 fingers,fair in ]2 fingers and poor in 6 fingers. The overall satisfactory rate was 60%. In group B, excellent results were achieved in 18 fingers, good in 6 fingers, fair in 2 fingers and no poor result. The overall satisfactory rate was 92%. There were no significant differences between the two groups in bone healing time and infection rate. Conclusion The lateral mini titanium plate fixation for treatment of proximal phalanx fractures can reduce tendon adhesion and ankylosis, therefore leading to better functional recovery. However, lateral fixation is less stable than dorsal fixation.

关 键 词：指骨 骨折 内固定术 微型钢板 

分 类 号：R684.7[医药卫生—骨科学]