近端指间关节骨折脱位患者的动态牵引联合切开复位内固定治疗  

Dynamic traction with open reduction internal fixation for fracture-dislocations of the proximal interphalangeal joint

作　　者：刘坤[1] 武竞衡[1] 陈山林[1] 田文[1] Jan van Aaken Pierre Hoffmeyer 田光磊[1] 

机构地区：[1]北京积水潭医院手外科,100035 [2]瑞士日内瓦大学手外科

出　　处：《中国骨与关节杂志》2017年第4期258-261,共4页Chinese Journal of Bone and Joint

摘　　要：目的研究动态牵引联合切开复位内固定术治疗近端指间关节(the proximal interphalangeal joint,PIPJ)骨折脱位的疗效。方法 2013年7月至2016年1月,采用动态牵引联合切开复位螺丝钉或克氏针内固定术治疗10例PIPJ骨折脱位。其中,男8例,女2例,平均年龄32岁。示指1例,中指2例,环指7例。骨折平均累及关节面的54%。10例于伤后1~9天,平均4天接受手术。采用手指PIPJ掌侧V形切口,Shotgun入路显露关节面骨折。直视下撬起塌陷的关节面,复位骨折块,以1~2枚?1.7 mm螺丝钉或2~3枚?0.8 mm克氏针固定骨折。其中,1例采用自体桡骨茎突松质骨移植,2例采用同种异体松质骨移植。闭合伤口后,安装动态牵引外固定架,术后第2天开始PIPJ主动活动,术后5~6周拆除外架。术后从临床表现、影像学结果和患者满意度3个方面进行评估。结果 10例均获3~29个月随访,平均12个月。无感染、异体骨排斥反应、克氏针松动及关节侧方不稳定等并发症发生。8例骨折愈合良好,无关节半脱位。2例出现关节面磨损,并再次进行手术。最后一次随访时,平均握力为对侧的90%,PIPJ平均关节活动度为97°,远端指间关节(the distal interphalangeal joint,DIPJ)平均关节活动度为68°。平均疼痛视觉模拟评分(visual analogue scale,VAS)为0.3分,平均Quick DASH(quick disabilities of arm,shoulder,and hand)评分为4分。10例均对结果满意,返回原工作岗位。结论动态牵引联合切开复位内固定术治疗PIPJ骨折脱位可最大限度地恢复关节面的解剖结构和关节活动度,疗效满意。Objective To investigate the outcomes of dynamic traction with open reduction internal fixation（ ORIF） for treatment of fracture-dislocations of the proximal interphalangealjoint（ PIPJ）. Methods From July 2013 to January 2016, 10 consecutive patients diagnosed with fracture-dislocations of the PIP joint were treated with dynamic traction and ORIF either with K-wires or mini-screws. Among all patients 8 were male and 2 were female. The average age of patients was 32 years. One index finger, 2 long fingers and 7 ring fingers were involved. The average articular area involved was 54%. All fractures were reduced and fixed with 1-2 K-wires（ 1.7 mm） or 2-3 mini-screws（ 0.8 mm） through a volar ＂shotgun＂ approach. Autologous bone grafting was performed in 1 patient and allogeneic bone graft in 2. After closure of the incision the dynamic external fixator was applied and was removed at 5-6 weeks postoperatively. The clinical and radiological outcomes and satisfaction of the patients were evaluated at the final follow-up. Results All patients had follow-up of 3 to 29 months（ average： 12 months）. No infection, allograft bone rejection, pin loosening or PIPJ instability occurred. Eight fractures united in good alignment and no joint subluxation occurred, 2 patients showed degenerative changes and had a supplementary surgery. Average grip strength was 90% of the unaffected side. The average range of motion（ ROM） of the PIPJ and distal interphalangeal joint（ DIPJ） was 97° and 68°, respectively. The average visual analogue scale（ VAS） pain score was 0.3. The average quick disabilities of the arm, shoulder and hand（ DASH） was 4（ range： 0-7）. All patients returned to their original occupation and all were satisfied with the results. Conclusions Dynamic traction with ORIF with K-wires or miniscrews for treatment of fracture-dislocations of the PIP joint can yield good objective and subjective outcomes.

关 键 词：指关节 指间关节 骨折脱位 骨折固定术 内 牵引 

分 类 号：R658.2[医药卫生—外科学]