可调式微型外固定架结合克氏针有限内固定治疗开放性近节指骨骨折伴掌指关节脱位  

Application and effective evaluation of mini external fixation combined with Kirschner’s Wire in the treatment of open proximal phalangeal fracture with metacarpophalangeal joint dislocation

作　　者：程二林 刘彦士 蔡飞宇 刘凯 范琛琛 任鹏[1] 艾合买提江·玉素甫[1] CHENG Erlin;LIU Yanshi;CAI Feiyu(Department ofTrauma and Microreconstructive,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,The Xinjiang Uygur Autonomous Region,830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《实用手外科杂志》2022年第1期14-18,共5页Journal of Practical Hand Surgery

基　　金：国家自然科学基金地区科学基金项目(项目编号:81560357)。

摘　　要：目的探讨可调式微型外固定架结合克氏针有限内固定在开放性近节指骨骨折伴掌指关节脱位治疗中的应用及疗效。方法2015年2月-2018年2月,采用可调式微型外固定架结合克氏针有限内固定治疗开放性近节指骨骨折伴掌指关节脱位13例。根据Gustilo分型:Ⅰ型7例,Ⅱ型4例,ⅢA型2例。根据Schenck指间关节骨折和脱位、半脱位分类标准分型:ⅠC型5例,ⅠD型4例,ⅡC型2例,ⅡD型1例,ⅢC型1例。所有患者急诊于臂丛神经阻滞麻醉下彻底清创,骨折和脱位关节复位满意后采用可调式微型外固定架结合克氏针行确定性的终末固定,皮肤软组织缺损者以游离植皮或局部皮瓣转移进行创面修复。结果术后13例创面均一期愈合,骨折复位良好并全部愈合,掌指关节均成功复位。全组患者均获随访,随访时间24~37个月,平均29个月。末次随访时,无再骨折及掌指关节再脱位发生。所有患者掌指关节活动满意,屈曲55°~90°,平均79°;背伸0°~20°,平均9°,均无明显关节疼痛。患肢手功能按照中华医学会手外科学会上肢部分功能评定试用标准进行评定:优6例,良5例,可2例,优良率为84.6%。结论可调式微型外固定架结合有限内固定是治疗开放性指骨骨折伴掌指关节脱位的有效方法,规律的随访、良好的针道护理及适当的功能训练有助于提高临床疗效。Objective To evaluate the application and effectiveness of mini external fixation combined with Kirschner's pin in the treatment of open proximal phalangeal fracture with metacarpophalangeal joint dislocation.Methods The retrospective study was conducted on 13 patients who suffered open proximal phalangeal fracture with metacarpophalangeal joint dislocation and underwent the treatment of mini external fixation combined with Kirschner's Wire at our institution from February 2015 to February 2018.According to the Gustilo classification,there were 7 cases in typeⅠ,4 cases in typeⅡ,and 2 cases in typeⅢA.According to the Schenck's classification,there were 5 cases in typeⅠC,4 cases in typeⅠD,2 cases inⅡC,1 case inⅡD and 1 case in typeⅢC.All patients were underwent the treatment of mini external fixation combined with Kirschner's Wire started by radical debridement.The soft tissue defects were managed by free skin grafting or local flap transfer.Results The wounds of all 13 patients healed in stageⅠ.All the fractures achieved union and the metacarpophalangeal joints were successfully reduced.The patients were followed up with an average of 29 months(24-37 months),and there was no refracture and redislocation.The movement of all the metacarpophalangeal joint obtained satisfactory results.The flexion ranged from 55°to 90°,with an average of 79°.Dorsiflexion 0°~20°,mean 9°,and no obvious joint pain was observed.The functional results were excellent in 6 cases,good in 5 cases,and fair in 2,the excellent and good rate was 84.6%.Conclusion The application of mini external fixation combined with Kirschner's Wire is an effective method for the treatment of open phalangeal fracture with metacarpophalangeal joint dislocation.Regular follow up,particular attention of wire site,and proper functional exercise contribute to the satisfactory results.

关 键 词：可调式微型外固定架 外固定 有限内固定 指骨骨折 掌指关节脱位 

分 类 号：R687.3[医药卫生—骨科学]