微型外固定支架牵张成骨技术治疗手外伤后掌指骨缺损  

Management of metacarpophalangeal bone defects after hand trauma by distraction osteogenesis with mini external fixation

作　　者：陈红浩[1] 贾亚超[1] 康庆林[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华创伤骨科杂志》2016年第12期1015-1021,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目（81272000）

摘　　要：目的探讨牵张成骨技术治疗手外伤后掌指骨骨缺损以及残指短缩的效果，并介绍外固定支架治疗的优势。方法对2010年6月至2015年12月治疗的16例手外伤后骨缺损患者资料进行回顾性研究，男11例，女5例；年龄20～45岁，平均32．5岁。16例患者共20处掌指骨骨缺损，8例单根掌骨骨缺损，2例同侧第2、3掌骨骨缺损，6例患指残端修整术后指骨短缩（其中拇指4例，示指1例，示指及中指1例）。掌指骨骨缺损1．0～3．1cm，平均1．8cm。在影像增强器的帮助下，采用手背侧切口，安装Orthofix单边延长外固定支架，近端（18指）或远端（2指）截骨延长。结果所有患者术后获9～26个月（平均12．2个月）随访。所有掌骨骨缺损均得以重建，所有短缩指骨均延长至满意的长度，延长区骨痂完全钙化。延长长度1．0～3．1cm，平均1．9cm；延长百分比26％～51％，平均34％；骨延长指数为60．0～87．1d/cm，平均70．9d/cm。按照中华医学会手外科学会上肢部分评定试用标准中手指总活动度（TAM）评定手部关节活动范围：优13处，良4处，可2处，差1处；优良率为85.0％。结论应用微型外固定支架骨延长与重建治疗掌指骨创伤后骨缺损方法可靠，可以有效地对缺损骨重建以及残指延长，进行早期功能锻炼有助于恢复手指的外观与功能。Objective To evaluate the outcomes of distraction osteogenesis with mini external fixa- tion in management of metaearpophalangeal bone defects after hand trauma. Methods From June 2010 to December 2015, 16 patients with metacarpophalangeal bone defects after hand trauma received distraction osteogenesis at our department. They were 11 men and 5 women, from 20 to 45 years of age （average, 32.5 years）. There were altogether 20 bone defects： 8 cases had single metacarpal bone defect, 2 unilateral second and third metacarpal bone defects and 6 phalangeal shortening after repair of digital stump （involving thumb in 4 cases, index finger in one and index and middle fingers in one） . The metacarpophalangeal bone defects averaged 1.8 cm （from 1.0 to 3.1 cm）. Under the fluoroscopic guide, 4 or 6 mini half-pins in one line were directly drilled into the dorsal aspect of the involved metacarpophalangeal bone before the Orthofix fixator was mounted. The proximal （18 digits） or distal （2 digits） osteotomy between the second and third pinholes was performed via the dorsal approach. The external fixator and pins were removed without anesthesia after callus maturation. Results Average follow-up period was 12.2 months （range, from 9 to 26 months）. All the metacarpal bone defects were reconstructed and all the phalangeal shortenings were lengthened; the bony callus was completely calcified at the lengthened part. The mean lengthening was 1.9 cm （from 1.0 to 3.1 era）; the percentage of lengthening ranged from 26% to 51% （average, 34% ）. The bone lengthening index （time cost by average 1 cm） was 70. 9 d/cm （from 60.0 to 87.1 d/cm）. According to the Tentative Assessment Criteria for Upper Extremity Function by Hand Surgery Society, Chinese Medical Association, the total activity of motion （TAM） was excellent in 13 cases, good in 4, fair in 2, and poor in one, yielding an excellent to good rate of 85.0%. Conclusion Distraction lengthening using mini external fixation is a valid option with

关 键 词：手 损伤 外固定器 骨延长术 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]