不过关节的交叉克氏针治疗西摩骨折的临床效果  

Clinical effect of crossed Kirschner wire without passing through joints in the treatment of Seymour fracture

作　　者：熊胜 巨积辉 吕永江 王桂洋 黄小龙 杜翔宇 肖航 Xiong Sheng;Ju Jihui;Lu Yongjiang;Wang Guiyang;Huang Xiaolong;Du Xiangyu;Xiao Hang(Department of Pediatric Orthopedics,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院小儿骨科,苏州215104

出　　处：《中华手外科杂志》2023年第3期193-196,共4页Chinese Journal of Hand Surgery

基　　金：江苏省苏州市民生科技项目(SS202092)。

摘　　要：目的探讨不过关节的交叉克氏针治疗西摩骨折的临床效果。方法自2016年4月至2021年10月,我院收治14例14指末节干骺端开放骨折的儿童,其中甲根损伤伴甲板剥脱2例,甲根损伤不伴甲板剥脱5例,甲根无损伤、甲板无剥脱7例。均不伴指屈、伸肌腱及血管神经损伤。清创后不拔除甲板,掀起甲根,显露骨折端,直视下观察,若无甲基质损伤,逆行钻入2枚克氏针交叉固定骨折,克氏针不过远指间关节,确认骨折固定牢固后复位甲根;若甲基质有损伤,于末节甲上皮两侧分别作纵形皮肤切口,牵开指背皮肤,直视下复位骨折用上述方法固定,回纳损伤的甲基质,缝合皮肤切口,石膏外固定3周后去除,4~6周后拔除克氏针,行手功能锻炼。结果术后14例伤口均Ⅰ期愈合,无伤口感染、针道感染、克氏针滑脱、断裂等早期并发症。术后随访时间为4~60个月,平均10个月,骨折愈合良好,无成角畸形,无骨骺早闭、发育障碍及骨桥形成,远指间关节主被动活动度正常。2例甲板表面欠平整、有少许横嵴,1例有少许纵嵴,11例甲体生长平整,无甲板畸形。患儿家属对指体的外形及功能满意。结论不过关节的交叉克氏针固定治疗西摩骨折,固定牢固,方法简单,并发症少,疗效满意,是一种较好的内固定方法。Objective To investigate the clinical efficacy of crossed Kirschner wire without passing through joints in the treatment of Seymour fracture.Methods From April 2016 to October 2021,14 children with open fracture of distal metaphysis of 14 fingers were treated in our hospital,including 2 cases of nail root injury with deck stripping,5 cases of nail root injury without deck stripping,and 7 cases without nail root injury and deck stripping.There was no injury of flexor and extensor tendons,blood vessels and nerves.After debridement,without pulling out the deck,the nail root was lifted to expose the fracture end and observe it under direct vision.If there was no nail matrix damage,two Kirschner wires were drilled retrogradely to cross fix the fracture,and the Kirschner wires was not passed through the distal interphalangeal joint.After confirming that the fracture was firmly fixed,the nail root was reset.If the nail matrix was damaged,the longitudinal skin incision was made on both sides of the nail epithelium of the distal segment,the skin on the dorsal finger was pulled out,the fracture was fixed with the above method under direct vision,the damaged nail matrix was recovered,the skin incision was sutured,and the plaster was removed after 3 weeks of external fixation,the Kirschner wires were pulled out after 4 to 6 weeks,and the hand function exercise was performed.Results The wounds of 14 cases achieved primary healing after operation,without wound infection,needle infection,Kirschner wire slippage,breakage and other early complications.The follow-up time was 4 to 60 months,with an average of 10 months.The fracture healed well without angulation,premature closure of epiphysis,developmental disorder and bone bridge formation.The active and passive range of motion of the distal interphalangeal joint was normal.The deck surface was not flat in 2 cases,with a few transverse ridges.A few longitudinal ridges occurred in 1 case,and the nail grew smoothly in 11 cases without deck deformity.The children's family members wer

关 键 词：骨折 儿童 内固定 甲床损伤 骨骺 

分 类 号：R726.8[医药卫生—儿科]