弹性牵引外架结合部分钩骨关节面移植治疗陈旧性指间关节损伤  

Elastic traction external frame combined with hemi-hamate autograft for the reconstruction of interphalangeal bone defects

作　　者：曹三利 张建政 王晓伟 吴卓 宋占林 赵建文 Cao Sanli;Zhang Jianzheng;Wang Xiaowei;Wu Zhuo;Song Zhanlin;Zhao Jianwen(Department of Orthopedics and Trauma,General Aviation Hospital,Beijing 100021,China;Orthopaedic District 5,Seventh Medical Center of General Hospital of the Chinese People’s Liberation Army,Beijing 100700,China)

机构地区：[1]航空总医院创伤骨科,北京100021 [2]中国人民解放军总医院第七医学中心骨科五区,北京100700

出　　处：《创伤外科杂志》2022年第2期124-127,共4页Journal of Traumatic Surgery

摘　　要：目的探讨弹性牵引外架结合部分钩骨腕掌关节面移植在手指指间关节结构性骨缺损功能重建中的价值。方法回顾性分析2016年11月—2019年1月解放军总医院第七医学中心骨科学部收治陈旧性指间关节部分结构性缺损患者17例(17指),男性15例15指,女性2例2指;年龄20~55岁,平均32.2岁。重物挤压伤6例6指,电锯切割伤10例10指,锤击伤1例1指;均采用钩骨部分腕掌关节面移植来进行手指关节缺损修复,术中采用微型螺钉及弹性牵引外架对修复部位进行固定,术后1周开始指导患者进行主动功能锻炼,术后6周拆除外固定架,逐渐加强关节功能锻炼。进行为期10个月以上的随访,观察患者恢复情况。结果本组随访10~30个月,平均12.0个月。患者手指关节骨性缺损结构性植骨均Ⅰ期愈合,关节无明显畸形,手指关节总活动度190°~260°,平均210°。根据手指关节总活动度(TAM)标准进行评价,优11指,良4指,中2指,优良率88.23%。结论弹性牵引外架结合部分钩骨关节面移植在治疗陈旧性指间关节损伤中效果确切,利于患者关节活动情况的改善,值得在临床推广应用。Objective To investigate the value of elastic traction external frame combined with hemi-hamate autograft for the reconstruction of interphalangeal bone defects.Methods Totally 17 patients with 17 fingers treated in The Department of Orthopedics of PLA General Hospital from Nov.2016 to Jan.2019 was selected,including 15 males and 2 females whose age ranged from 20 to 55 years,with an average of 32.2 years.Six cases were injured by heavy weight crushing,10 cases were injured by electric saw,and 1 case was injured by hammer.All the patients were selected because of partial structural defect of interphalangeal joint,and repaired by transfer of hamate articular surface.Mini-screw and elastic traction frame were used to fix the repaired part.The patients were guided to take active functional exercise 1 week after operation,and the external fixation was removed 6 weeks after operation to gradually strengthen joint functional exercise.The patients were followed up at least 10 months for recovery.Results The patients were followed up for 10 to 30 months,with an average of 12.0 months.All the patients'finger joint bone defect and structural bone graft healed in the first stage,and there was no obvious joint deformity.The patients were satisfied with the joint movement,and the total motion range of the finger was 190.0°-260.0°,with an average of 210.0°.Based on the total active motion(TAM)evaluation,the results was rated as excellent in 11 fingers,good in 4 fingers,fair in 2 fingers.The rate of excellent and good was 88.23%.Conclusion Elastic traction external frame combined with hemi-hamate autograft is effective in the treatment of old interphalangeal joint injury,which is conducive to the improvement of patients'joint activity,and is worthy of further clinical application.

关 键 词：手指关节 骨缺损 外固定架 修复与重建 

分 类 号：R687.3[医药卫生—骨科学]