动态牵引外固定联合内固定治疗拇指近节指骨基底部粉碎性骨折  

Dynamic external traction combined with internal fixation for treatment of comminuted intra-articular fractures of the base of the thumb proximal phalanx

作　　者：白印伟[1] 张振伟[1] 余少校[1] 李征[1] 周望高[1] 吴文溢 曾锦浩[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,深圳518104

出　　处：《中华手外科杂志》2016年第4期257-259,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨治疗拇指近节指骨基底部粉碎性骨折，在行手术内固定同时应用动态牵引外固定治疗的临床效果。方法自2009年3月至2014年7月，对7例拇指近节指骨基底部累及掌指关节内的粉碎性骨折患者（AO分型为C型），行开放／闭合复位内固定术，同时辅以动态牵引外固定架固定。术后早期行患指功能康复训练，随访拇指掌指关节活动度、捏力、并发症等。结果术后随访13～32个月，平均18个月，石膏托固定平均7．7d（3～14d），平均4．3周拆除外固定架（4～6周），平均7．2周取出内固定物（6～9周）。所有患者均能返回原工作岗位，拇指掌指关节屈35°-50°，平均42．4°；伸5°-10°，平均8．6°。捏力平均为对侧89％。根据中华医学会手外科学会手功能评定标准：优5例，良2例。结论在拇指掌指关节以动态牵引外固定结合内固定方法，可有效固定骨折块，允许关节早期活动，具有动态可变牵引力，运动中可有效维持关节稳定，减少因长期制动导致的关节附属结构粘连、挛缩。Objective To document the efficacy of our modified dynamic external traction system that is applied concomitantly with internal fixation for comminnted fractures at the base of thumb proximal phalanx. Methods From March 2009 to July 2014, 7 cases of comminuted fractures at the base of thumb proximal phalanx with metacarpophalangeal（MP） joint involvement （AO type C fractures） were treated with open or close reduction and internal fixation. Meanwhile a dynmnic external traction system was applied. Postoperative exercise started early. Range of motion of the MP joint, pinch strength and postoperative complications were evaluated. Results Postoperative follow-up period ranged from 13 to 32 months, with an average of 18 months. The mean plaster splint immobilization time was 7.7 days （range, 3 to 14 days）. The external flxator was removed at 4.3 weeks on average （range, 4 to 6 weeks）. The internal fixation hardware removal time was 7.2 weeks postoperatively on average （range, 6 to 9 weeks）. All the patients were able to return to their original jobs. The average active range of motion for the MP joint of the thumb was 8.6° （range, 5° to 10°） extension and 42.4° （range, 35° to 50°） flexion. Mean pinch strength was 89% of that of the contralateral side. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 5 cases and good in 2 cases. Conclusion Dynamic external traction system combined with internal fixation can provide reliable fracture fixation and allow early mobilization of the MP joint. The variable traction force can effectively maintain joint stability during movement and reduce adhesion and contracture of the joint.

关 键 词：拇指 指骨 关节内骨折 动态牵引 

分 类 号：R687.3[医药卫生—骨科学]