应用克氏针内固定联合微型外固定架治疗掌指骨关节内骨折  

Treatment of metacarpophalangeal fracture with internal fixation of Kirschner's needle and micro external fixator

作　　者：刘井达[1] 李建峰[1] 张文桐[1] 李海雷[1] 王志梦 张涛[1] 李冬梅[1] 赵亮[1] 赵民[1] 李大村[1] LIU Jingda;LI Jianfeng;ZHANG Wentong(Department of Hand Foot Surgery,Shunyi District Hospital,Beijing,101300,China)

机构地区：[1]北京市顺义区医院手足外科,北京101300

出　　处：《实用手外科杂志》2023年第2期205-207,共3页Journal of Practical Hand Surgery

摘　　要：目的 探讨应用克氏针内固定联合微型外固定架治疗掌指骨关节内骨折方法与疗效。方法2017年1月-2022年1月,应用克氏针内固定联合微型外固定架治疗掌指骨关节内骨折50例,均采用急诊或早期有限切开复位、克氏针内固定联合微型外固定架外固定治疗,4周拔出克氏针,6周拆除外固定架,在康复师指导下行系统功能训练。结果 50例全部获得随访,随访时间3~18个月,平均9个月,所有切口均一期愈合。骨折愈合4~8周,平均5.8周,患者末次复查X线片示骨折线消失,骨折愈合,关节面平整。所有患者愈合后均关节稳定,活动度协调,未出现脱位及半脱位,无感染及指体坏死病例,3例(6%)出现轻度关节退变。末次随访采用美国手外科协会TAFS标准评定手指功能:优42例,良6例,可2例。TAM功能评分:优45例,良2例,可3例,优良率94%。结论 应用克氏针内固定联合微型外固定架治疗掌指骨关节内骨折,操作简单,能最大限度地从不同维度纠正骨折力线,恢复关节面的平整,减少对关节周围结构的激惹,无需二次手术取出内固定装置,临床效果满意,值得推广应用。Objective To investigate the treatment of metacarpophalangeal fracture with internal fixation of Kirschner wire and micro external fixator frame.Methods From January 2017 to January 2022,50 cases of intra-articular fractures of metacarpal and phalangeal bones were treated with internal fixation of Kirschner wire combined with external fixation of micro external fixator.Emergency treatment or early limited open reduction,internal fixation with Kirschner wires combined with external fixation with miniature external fixator were used.Kirschner wires were removed at 4 weeks,the external fixator was removed at 6 weeks,and the system function exercise was conducted under the guidance of therapists.Results All 50 cases were followed up for 3-18 months(mean 9 months);fracture healing lasted 4-8 weeks(mean 5.8 weeks);all incisions healed in the first stage.After healing,all patients had stable joints with coordinated range of motion and no dislocation or subluxation.No infection or finger body necrosis was reported.Mild joint degeneration occurred in 3 cases(6%).At the last follow-up,according to the TAFS criteria,42 cases were graded excellent,6 good,and 2 fair.TAM function score:Excellent 45 cases,good 4 cases,fair 1 case.Conclusion The application of Kirschner wire internal fixation combined with external fixation of micro external fixator in the treatment of metacarpal and phalangeal fractures is simple in operation,can maximize the correction of fracture force lines from different dimensions,restore the joint surface flat,reduce the irritation to the structure around the joint,no second operation to remove the internal fixation device,the clinical effect is satisfactory,worthy of promotion and application.

关 键 词：克氏针 微型外固定架 掌指骨关节内骨折 

分 类 号：R687.3[医药卫生—骨科学]