Orthofix外固定支架治疗累及关节的闭合掌指骨骨折  

Treatment of closed metacarpal and phalangeal fractures involving joints with Orthofix external fixator

作　　者：雷伟 王锟 刘毅强 李恭驰[1] 翁雨雄[1] Lei Wei;Wang Kun;Liu Yiqiang;Li Gongchi;Weng Yuxiong(Department of Hand Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院手外科,武汉430022

出　　处：《中华手外科杂志》2020年第3期187-189,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨微型Orthofix外固定支架在治疗累及关节的闭合掌指骨骨折中的应用及疗效。方法自2015年9月至2018年4月我们应用微型Orthofix外固定支架治疗累及关节的闭合掌指骨骨折患者24例,术中透视下闭合复位外固定支架跨关节固定于功能位,术后4周松开外固定支架于关节轴线固定装置(以便关节可以沿轴线方向行适度主动屈伸活动)。术后6~8周复查X线片,视骨折愈合情况取出外固定支架并测量患者主动关节活动范围、疼痛评分及手指捏握力量,并指导患者进行功能康复锻炼,外固定支架拆除8周后随访时复查X线片,评估骨折愈合情况及测量关节活动功能。结果术后6~8周复查X线片结果显示21例患者骨折愈合良好,1例因外固定支架松动出现骨折延迟愈合。外固定拆除8周后复查,22例患者掌指关节平均主动屈伸活动范围为86.9°,近指间关节84.8°,VAS评分1.4分。手指捏握力量恢复至健侧的92%。结论微型Orthofix外固定支架治疗累及关节的闭合掌指骨骨折,对关节及周围软组织损伤小,骨折愈合良好。术后早期即可进行功能锻炼,后期功能恢复满意。Objective To explore the application and clinical efficacy of mini-Orthofix external fixator in the treatment of closed metacarpal and phalangeal fractures involving joints.Methods From September 2015 to April 2018, 24 patients with closed metacarpal and phalangeal fractures involving joints were treated with mini-Orthofix external fixator. The close reduction and external fixation in the functional position under intraoperative fluoroscopy was performed. The external fixator was loosened in the joint axis fixator 4 weeks after the operation (so that the joint can perform moderate active flexion and extension along the axis direction). The X-ray examination was conducted 6 to 8 weeks after operation. The external fixator was taken out according to the fracture healing situation, and the active joint range, pain score and finger holding strength were measured. The patients were instructed to carry out functional rehabilitation exercise. The X-ray examination was conducted 8 weeks after removal of external fixator, and the fracture healing and joint activity were evaluated.Results After 6 to 8 weeks of operation, the X-ray results showed that 21 patients had good fracture healing, and 1 patient had delayed fracture healing due to the loosening of external fixator. After 8 weeks of removal of external fixator, the average range of active flexion and extension was 86.9° in metacarpophalangeal joint and 84.8° in proximal interphalangeal joint in 22 patients followed up. The average VAS score was 1.4. The grip strength of fingers returned to 92% of that of the healthy side.Conclusion The treatment of closed metacarpal and phalangeal fractures involving joints with mini-Orthofix external fixator has little damage to the joints and surrounding soft tissues, and the fractures are well healed. The functional exercise can be carried out in the early stage and the functional recovery is satisfactory in the later stage.

关 键 词：掌骨 指骨 骨折 微型Orthofix外固定支架 

分 类 号：R658.2[医药卫生—外科学]