一期闭合复位双克氏针弹性加压固定治疗Wehbe-SchneiderⅠB型及ⅡB型骨性锤状指  

Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires

作　　者：李伟峰 张敬标 安庆 郑志远 官建中[2,3] LI Weifeng;ZHANG Jingbiao;AN Qing;ZHENG Zhiyuan;GUAN Jianzhong(The First Department of Orthopedics,the People's Hospital of Lixin County,Bozhou Anhui,236700,P.R.China;Department of Orthopedics,the First Affiliated Hospital,Bengbu Medical College,Bengbu Anhui,233004,P.R.China;Anhui Province Key Laboratory of Tissue Transplantation,Bengbu Anhui,233030,P.R.China)

机构地区：[1]利辛县人民医院骨一科,安徽亳州236700 [2]蚌埠医学院第一附属医院骨科,安徽蚌埠233004 [3]组织移植安徽省重点实验室,安徽蚌埠233030

出　　处：《中国修复重建外科杂志》2022年第4期400-404,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽高校自然科学研究项目(KJ2020ZD51);蚌埠医学院研究生科研创新计划项目(Byycx21075)。

摘　　要：目的 探讨一期闭合复位双克氏针弹性加压固定治疗Wehbe-SchneiderⅠB、ⅡB型骨性锤状指的疗效。方法 2017年5月—2020年6月,采用一期闭合复位双克氏针弹性加压固定治疗21例Wehbe-SchneiderⅠB、ⅡB型骨性锤状指患者。男15例,女6例;年龄19-62岁,平均39.2岁。致伤原因:运动伤9例,戳伤7例,扭伤5例。受伤至入院时间5-72 h,平均21.0 h。损伤指别:示指2例,中指8例,环指9例,小指2例。远端指间关节(distal interphalangeal joint,DIPJ)主动背伸丧失角度为(40.04±4.02)°。根据Wehbe-Schneider分型标准:ⅠB型10例,ⅡB型11例。术后6周待X线片复查示撕脱骨折达骨性愈合后取出克氏针,并开始患指功能锻炼。结果 手术时间35-55 min,平均43.9 min;住院时间2-5 d,平均3.4 d。术后无相关并发症发生。患者均获随访,随访时间6-12个月,平均8.8个月。X线片复查示撕脱骨折均达骨性愈合,愈合时间4-6周,平均5.3周。术后6周取出克氏针后,DIPJ主动屈曲时疼痛视觉模拟评分(VAS)为1-3分,平均1.6分;被动屈曲至最大活动度时为2-5分,平均3.1分。患指DIPJ主动背伸丧失角度为(2.14±2.54)°,与术前比较差异有统计学意义(t=52.186,P<0.001)。患指DIPJ主动屈曲角度为(79.52±6.31)°,与对应健指(81.90±5.36)°比较,差异无统计学意义(t=1.319,P=0.195)。术后3个月,根据Crawford功能评定标准评价,疗效达优11例、良9例、一般1例,优良率为95.24%。结论 对于Wehbe-SchneiderⅠB、ⅡB型骨性锤状指,一期闭合复位双克氏针弹性加压固定可有效纠正畸形,具有操作简便、手术无切口不影响患指外观等优点。Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with onestage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years(range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours(mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint(DIPJ) was(40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes(mean, 43.9 minutes). The length of hospital stay was 2-5 days(mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months(mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks(mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale(VAS) score of pain during active flexion of the DIPJ was 1-3(mean, 1.6);the VAS score of pain was2-5(mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was(2.14±2.54)°, showing significant difference when compared with preoperative angle(t=52.186,P<0.001). There was no significant differen

关 键 词：骨性锤状指 撕脱骨折 闭合复位 克氏针 内固定 

分 类 号：R687.3[医药卫生—骨科学]