末节指骨背侧撕脱骨折钩钢板与克氏针固定的疗效分析  

Clinical analysis of hook plate and Kirschner wire fixation for the treatment of dorsal phalangeal avulsion fractures at the base of the distal segment

作　　者：王光辉[1] 傅子财 刘建全[1] 赵喆[1] 陈小强 李永胜[1] 尹建文 程翔宇 刘澍雨 梁新枝 李嘉贝 王满宜 李文翠[1] Wang Guanghui;Fu Zicai;Liu Jianquan;Zhao Zhe;Chen Xiaoqiang;Li Yongsheng;Yin Jianwen;Cheng Xiangyu;Liu Shuyu;Liang Xinzhi;Li Jiabei;Wang Manyi;Li Wencui(Department of Foot and Ankle Surgery and Hand Surgery,the First Affiliated Hospital of Shenzhen University(Shenzhen Second People′s Hospital),Shenzhen 518035,China)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)足踝外科手外科,深圳518035

出　　处：《中华手外科杂志》2022年第3期161-164,共4页Chinese Journal of Hand Surgery

基　　金：深圳市卫生和计划生育委员会三名工程(SZSM201612086);广东省临床重点专科—骨科(2000005);深圳市医学重点学科建设基金(SZXK025);广东省高水平临床重点专科(深圳市配套建设经费)资助(SZGSP007)。

摘　　要：目的对比微型钩钢板与克氏针固定治疗末节指骨基底背侧撕脱骨折的临床疗效。方法自2016年8月至2019年10月我院共收治36例36指末节指骨基底背侧撕脱骨折患者,其中19例采用微型钩钢板复位固定,17例采用闭合克氏针固定。术后随访使用Crawford评分标准、愈合时间、指间关节主动背伸缺失角度、指间关节主动屈曲缺失角度比较两种治疗方法的临床疗效。结果术后36例均获得随访,时间为4~26个月,平均8.7个月。按Crawford评分标准:微型钩钢板组优7例、良5例、中7例;克氏针组优4例、良8例、中5例,两组的优良例数比较差异无统计学意义(P=0.906)。平均愈合时间,微型钩钢板组为5.44周,克氏针组为6.41周,两组比较差异有统计学意义(t=3.067,P<0.05)。远指间关节主动背伸平均缺失角度,微型钩钢板组缺失(7.02±0.97)°,克氏针组缺失(8.78±1.11)°,两组比较差异有统计学意义(t=5.066,P<0.05)。远指间关节主动屈曲平均缺失角度,微型钩钢板组缺失(5.11±1.37)°,克氏针组缺失(6.91±0.98)°,两组比较差异有统计学意义(t=4.567,P<0.05)。术后并发症:微型钩钢板组1例出现感染,4例指甲出现轻微隆起脊;克氏针组3例出现针道反应。两组并发症发生例数差异无统计学意义(OR的95%可信区间[0.174,9.997],P=0.695)。结论采用微型钩钢板治疗末节指骨基底背侧撕脱骨折,术后指间关节主动背伸和屈曲活动范围恢复优于克氏针固定,且术后愈合时间也短于克氏针固定。Objective To compare the clinical efficacy of micro hook plate and Kirschner wire fixation in the treatment of dorsal phalangeal avulsion fractures at the base of the distal segment.Methods From August 2016 to October 2019,36 patients with dorsal phalangeal avulsion fractures at the base of the distal segment were treated in our hospital,of which 19 cases were fixed with micro hook plate and 17 cases were fixed with Kirschner wire.The clinical outcomes of the two treatment methods were compared by using Crawford scoring standard,healing time,active back extension loss angle of interphalangeal joint and active flexion loss angle of interphalangeal joint.Results All the 36 cases were follow-up for 4 to 26 months with an average of 8.7 months.According to the Crawford scoring standard,the results of micro hook plate group were rated as excellent in 7 cases,good in 5 cases,fair in 7 cases;the results of Kirschner wire group were rated as excellent in 4 cases,good in 8 cases,fair in 5 cases.There was no significant difference in the number of excellent and good cases between the two groups(P=0.906).The average healing time was 5.44 weeks in micro hook plate group and 6.41 weeks in Kirschner wire group.There was significant difference between the two groups(t=3.067,P<0.05).The average loss angle of active extension of distal interphalangeal joint was(7.02±0.97)°in micro hook plate group and(8.78±1.11)°in Kirschner wire group(t=5.066,P<0.05).The average loss angle of active flexion of distal interphalangeal joint was(5.11±1.37)°in micro hook plate group and(6.91±0.98)°in Kirschner wire group(t=4.567,P<0.05).The postoperative complications were that 1 case had infection and 4 cases had slight nail ridge in the micro hook plate group,while 3 cases had needle channel reaction in Kirschner wire group.There was no significant difference in the number of complications between the two groups(95%confidence interval of OR was[0.174,9.997],P=0.695).Conclusion When the dorsal phalangeal avulsion fractures at the base of th

关 键 词：指损伤 骨折固定术 内 骨性锤状指 微型钩钢板 克氏针 

分 类 号：R687.3[医药卫生—骨科学]