切开复位克氏针固定与闭合复位石膏外固定治疗Bennett骨折疗效比较  

Comparison of curative effect between open reduction and Kirschner wire fixation and closed reduction with plaster external fixation in the treatment of Bennett’s fracture

作　　者：李兵[1] 施剑烽 尹刚 Li Bing;Shi Jianfeng;Yin Gang(Department of Hand and Foot Surgery,People*s Hospital of Suzhou High-tech Zone,Suzhou v Jiangsu 215129,China;Department of Orthopedics,Shanghai First People's Hospital,Shanghai 200080,China)

机构地区：[1]苏州高新区人民医院手足外科,江苏苏州215129 [2]上海市第一人民医院骨科,上海200080

出　　处：《创伤外科杂志》2022年第6期445-450,共6页Journal of Traumatic Surgery

基　　金：中国博士后科学基金项目(2017M623362)。

摘　　要：目的 探讨切开复位克氏针固定与闭合复位石膏外固定治疗第1掌骨基底部骨折脱位(Bennett骨折)患者疗效比较。方法 前瞻性研究2018年9月—2020年1月苏州高新区人民医院手足外科收治Bennett骨折患者72例,男性42例,女性30例;年龄17~62岁,平均40.2岁。病程2~4d,平均3.2d。道路交通伤30例,重物砸伤18例,跌打损伤17例,其他7例。采用单双数标记法随机分为对照组和观察组,各36例。对照组采用闭合复位石膏外固定方法,观察组采用切开复位克氏针固定方法,术后3个月,采用指关节总活动度系统评定两组患者优良率;采用上肢功能评定量表(DASH)评价两组患者术前、术后3、6、12个月的上肢功能,比较两组患者术后12个月内骨折术后部位并发症(延迟愈合、伤口感染、创伤性关节炎等)情况。结果 术后3个月,观察组指关节总活动度优良例数显著高于对照组34例(94%)vs.27例(75%),P=0.022;术后3、6、12个月两组患者DASH逐渐降低,且相同时点观察组的评分显著低于对照组,差异有统计学意义(P<0.05);术后12个月内,观察组并发症4例(11%),较对照组6例(17%)差异无统计学意义(P>0.05)。结论 与常规非手术手法闭合复位石膏外固定方法比较,切开复位克氏针内固定治疗Bennett骨折可以有效提高患者近期临床疗效优良率和患者掌指关节功能远期恢复质量。Objective To investigate the effect of open reduction and Kirschner wire fixation and closed reduction with plaster external fixation in the treatment of patients with Bennett’s fracture.Methods From Sep.2018 to Jan.2020,72 patients with Bennett’s fracture were admitted to the Department of Hand and Foot Surgery,Suzhou High-tech Zone People’s Hospital,including 42 males and 30 females;the age ranged from 17 to 62 years,with an average of 40.2 years;the course of disease was 2 to 4 days,an average of 3.2 days;there were 30 cases of traffic accident injuries,18 cases of heavy object smashing injuries,17 cases of falls and 7 cases of other injuries.The patients were randomly divided into the control group and the observation group by odd and even numbers,with 36 cases in each group.The control group was treated with closed reduction and plaster external fixation,and the observation group was treated with open reduction and Kirschner wire fixation.Three months after operation,the total range of motion of the finger joints was used to evaluate the excellent and good rates of the two groups;disabilities of the arm,shoulder and hand(DASH)was used to evaluate the upper extremity function of the two groups before surgery,3 months,6 months,and 12 months after surgery,and the postoperative complications(delayed healing,wound infection,traumatic joints)were compared between the two groups within 12 months after surgery.Results At 3 months after operation,the number of cases with excellent and good total range of motion of the finger joints in the observation group was significantly higher than that in the control group[34 cases(94%)vs.27 cases(75%),P=0.022].At 3,6,12 months,the DASH scores of the upper limb function assessment scale of the two groups of patients gradually decreased,and the scores of the observation group at the same time point were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).There were 4 cases(11%)of complications in the group,and the dif

关 键 词：BENNETT骨折 复位 克氏针 石膏 固定 

分 类 号：R687.3[医药卫生—骨科学]