钩形钛板固定治疗近节指骨底侧方骨折  

Treatment of the lateral fractures of proximal phalangeal base with fixation of titanium hook plate

作　　者：杨勇[1] 刘坤[1] 李忠哲[1] 孙丽颖[1] 杨辰[1] 陈山林[1] 田文[1] 张友乐[1] 田光磊[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《骨科临床与研究杂志》2017年第5期262-266,共5页Journal Of Clinical Orthopedics And Research

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015-3-036);人力资源和社会保障部留学人员科技活动项目择优资助~~

摘　　要：目的探讨钩形钛板固定治疗近节指骨底侧方骨折的疗效。方法纳入2013年3月至2016年10月北京积水潭医院手外科采用切开复位钩形钛板固定近节指骨底侧方骨折患者7例。手术指征包括近节指骨侧方基底骨折移位>2 mm、骨折块翻转以及关节面台阶>1 mm。术中选择患指的侧方入路,骨折复位后以钩形钛板或钩形钛板结合克氏针固定骨折。通过疼痛视觉模拟评分(VAS)、手指总主动活动度(TAM)以及掌指关节活动度评价患指术后功能,摄患指正侧位X线评价骨折愈合情况。结果 7例患者中,男6例,女1例;年龄(29.6±10.7)(17~48)岁。骨折累及右侧4例,左侧3例;中指2例,环指2例,小指3例。骨折原因分别为跌倒致伤3例,他人扭伤2例,交通事故伤1例,电钻扭伤1例。随访(11.4±5.2)(6~21)个月。指骨骨折均完全愈合,愈合时间(47.0±5.3)(42~56)d。末次随访时,VAS评分(0.6±0.8)分;患侧手指TAM(269.7±3.0)°,健侧手指TAM(272.9±3.9)°,P=0.069;掌指关节活动度患侧为(89.3±2.2)°,健侧为(90.9±3.3)°,P=0.062,无掌指关节不稳定、切口感染及骨折不愈合等术后并发症。结论切开复位钩形钛板固定治疗近节指骨底侧方骨折,关节面复位好,固定强度满足术后早期手指功能锻炼,是治疗近节指骨底侧方骨折有效的手术方法。Objective To evaluate the treatment effects for avulsion fractures of the proximal phalangeal base with lateral fixation of titanium hook plate. Methods From March 2013 to October 2016,7 patients suffered from avulsion fractures of the proximal phalangeal base were treated with lateral fixation of titanium hook plate. Surgical indications for the avulsion fracture included fracture fragment significant displacement and joint surface step 1 mm. All fractures were exposed by lateral approach. After the reduction,the fractures were fixed with hook plate or hook plate supplemented Kirschner wire. Visual analogue scale（ VAS）,total active motion（ TAM）,and metacarpophalangeal joint stability were used to evaluate postoperative function. All patients took X-rays during follow-up. Results There were 7 patients,6 males and one female,aged（ 29. 6 ±10. 7）（ ranged,17-48 years）. Fractures included 4 cases on the right side and 3 cases on the left. According to the site of fracture,2 cases involved middle finger,2 cases involved ring finger,3 cases involved little finger. The follow-up period was（ 11. 4 ± 5. 2） months ranging between 6 and 21 months. The phalanx fractures were healed in（ 47. 0 ± 5. 3） days ranging from 42 to 56 days. At final follow-up,the VAS score was（ 0. 6 ± 0. 8）,TAM of injuried fingers was（ 269. 7 ± 3. 0） ° and TAM of contralateral side averaged was（ 272. 9 ± 3. 9） °,P = 0. 069. Range of motion of metacarpophalangeal joint in injuried fingers was（ 89. 3 ±2. 2） ° and range of motion of contralateral side was（ 90. 9 ± 3. 3） °,P = 0. 062. There was no postoperative complication such as metacarpophalangeal joint instability,wound infection and fracture nonunion in this group.Conclusion Avulsion fractures of the proximal phalangeal base could be treated with lateral fixation of titanium hook plate. The procedure provide stability and allow early motion,which could help maintain joint reduction and obtain reliable fracture healing. This technique may be an

关 键 词：指骨 骨折固定术 内 掌指关节 钩形钛板 

分 类 号：R687.3[医药卫生—骨科学]