克氏针弹性固定治疗Doyle Ⅰ、Ⅱ型锤状指近期疗效观察  

Short-term effectiveness of Kirschner wire elastic fixation in treatment of Doyle type Ⅰand Ⅱ mallet finger

作　　者：闫浩[1] 谭权昌 周胜[1] 杨俊生[1] 李力毅[1] 汪剑龄[1] 施晓成[1] 夏超[1] 李颖[1] 

机构地区：[1]中国人民解放军第四五四医院骨科,南京210001

出　　处：《中国修复重建外科杂志》2017年第11期1287-1290,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨克氏针弹性固定治疗DoyleⅠ、Ⅱ型锤状指的近期疗效。方法 2016年7月—2017年3月,收治DoyleⅠ、Ⅱ型锤状指18例。男12例,女6例;年龄16~61岁,平均45岁。损伤指别:示指2例,中指3例,环指10例,小指3例。受伤至手术时间2 h^45 d,中位时间5.5 h。闭合性损伤8例,开放性损伤10例。单纯指伸肌腱断裂14例,伴撕脱性骨折的伸肌腱止点断裂4例。采用克氏针弹性跨关节固定远节指间关节(distal interphalangeal joints,DIPJ)于过伸位,6周后去除克氏针并进行功能锻炼。结果手术时间34~53 min,平均38.9 min。患者均获随访,随访时间3~8个月,平均5个月。术后切口均Ⅰ期愈合;患指固定期间未发生克氏针松动、针眼处感染。患者锤状指畸形均得到纠正,术后6周拔除克氏针后,DIPJ被动活动无明显受限,主动屈曲角度为(75.83±11.15)°,与健侧对应指(85.28±6.06)°比较,差异有统计学意义(t=3.158,P=0.003)。术后8个月,15例获随访患者患指DIPJ主动屈曲角度为(82.67±6.78)°,与健侧对应指(86.00±5.73)°比较,差异无统计学意义(t=1.454,P=0.157)。术后6周拔除克氏针后,DIPJ主动屈曲时疼痛视觉模拟评分(VAS)为(1.78±0.88)分,被动屈曲至最大关节活动度时VAS评分为(3.06±1.06)分。术后3个月,根据总主动活动度(TAM)评定标准,获优10例、良5例、中2例、差1例,优良率为83.33%;患者满意度Likert评分为3~5分,平均4.2分。结论克氏针弹性固定治疗DoyleⅠ、Ⅱ型锤状指,能有效修复指伸肌腱,纠正锤状指畸形,利于远期DIPJ屈伸功能恢复。Objective To evaluate the short-term effectiveness of Kirschner wire（K-wire） elastic fixation in the treatment of Doyle type Ⅰ and Ⅱ mallet finger. Methods Between July 2016 and March 2017, 18 patients with Doyle type Ⅰ and Ⅱ mallet finger were treated. There were 12 males and 6 males, with an average age of 45 years（range, 16-61 years）. The index finger was involved in 2 cases, the middle finger in 3 cases, the ring finger in 10 cases, and the little finger in 3 cases. The interval from injury to operation ranged from 2 hours to 45 days（median, 5.5 hours）. There were8 patients of closed wound and 10 patients of open wound. Fourteen patients were simply extensor tendon rupture and4 were extensor tendon rupture complicated with avulsion fracture. The distal interphalangeal joints（DIPJ） of injured fingers were elastically fixed with the K-wire at mild dorsal extend position. The K-wire was removed after 6 weeks, and the functional training started. Results The operation time was 34-53 minutes（mean, 38.9 minutes）. Patients were followed up 3-8 months（mean, 5 months）. All incisions healed primarily and no K-wire loosening or infection happened during the period of fixation. All mallet fingers were corrected. The range of motion（ROM） in terms of active flexion of injured DIPJ was（75.83±11.15）° at 6 weeks after operation, showing significant difference when compared with the normal DIPJ of contralateral finger [（85.28±6.06）°]（t=3.158, P=0.003）. The ROM in terms of active flexion was（82.67±6.78）°in 15 patients who were followed up at 8 months after operation, showing no significant difference when compared with the normal DIPJ of contralateral finger [（86.00±5.73）°]（t=1.454, P=0.157）. After the removal of K-wire at 6 weeks, visual analogue scale（VAS） score of active flexion and of passive flexion to maximum angle were 1.78±0.88 and 3.06±1.06,respectively. According to the total active motion criteria, the effectiveness was rated as excellent in 10

关 键 词：锤状指 克氏针 弹性固定 指伸肌腱 关节活动度 

分 类 号：R687.3[医药卫生—骨科学]