8字捆绑联合弹性固定治疗骨性锤状指  

Combination of bundling bone fragment with 8-figure binding and elastic fixation in the treatment of bony mallet finger

作　　者：江起庭 李智 邱福平 何兵 王斌 余红 李涛 Jiang Qiting;Li Zhi;Qiu Fuping;He Bing;Wang Bin;Yu Hong;Li Tao(Department of Hand and Foot Microsurgery,Nanjing Jiangbei Hospital,Nanjing 210048,China)

机构地区：[1]南京江北医院手足显微外科,南京210048

出　　处：《中华解剖与临床杂志》2023年第10期652-656,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨8字捆绑联合弹性固定治疗骨性锤状指的临床疗效及可行性。方法病例系列报告。纳入2021年5月—2022年7月南京江北医院手足显微外科骨性锤状指患者10例(10指)。其中男4例、女6例,年龄22~56岁。根据Wehbe和Schneider分型,Ⅰa型2例、Ⅰb型3例、Ⅱa型2例、Ⅱb型3例,均采用8字捆绑法固定末节指骨基底部撕脱的骨块,同时应用克氏针弹性固定远指间关节。术后8周拔除克氏针后逐步加强伤指伸屈运动,测量伤指及各关节的主动屈伸活动范围(ROM)及手指总主动活动度(TAM),记录末次随访伤指远指间关节ROM和TAM,参照美国手外科协会TAM系统评定手指功能。结果术后患者切口均一期愈合,锤状指畸形均完全矫正,无钉道感染及断钉现象。10例患者术后均获随访,随访时间为6.0~7.5个月。末次随访时,伤指的远指间关节ROM为28.8°~36.2°[30.2°(30.1°,33.2°)],TAM为223.8°~236.3°[225.5°(225.1°,232.4°)],与健侧指的ROM及TAM比较差异均无统计学意义(Z=-4.66、-1.32,P值均>0.05);参照TAM系统评定手指功能:优7例、良3例。结论8字捆绑联合弹性固定治疗骨性锤状指,切口小,操作简单,可最大限度重建手功能,获得满意的手术效果,是一种有效且实用的治疗骨性锤状指的方法。Objective This study aimed to discuss the clinical curative effect and feasibility of the combination of bundling bone fragment with 8-figure binding and elastic fixation in the treatment of bony mallet finger.Methods Retrospective analysis was performed on 10 patients(10 digits)with bony mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to July 2022,including four males and six females,aged 22-56 years old.Based on the Wehbe and Schneider classification,there were two cases of type Ia,three cases of type Ib,two cases of typeⅡa,and three cases of typeⅡb.During the procedure,the avulsion fracture of the base of the distal phalanx in the bony mallet finger was due to the combination of bundling bone fragment with 8-figure binding and Kirschner wire elastic fixation.After 8 weeks,the Kirschner wire was removed and flexion and extension of the affected finger were gradually increased;the range of motion(ROM)and the total active range of motion(TAM)of the finger were recorded,and the healthy side of the ROM and TAM slightly differed.Finger function was evaluated in accordance with the TAM system of the American Association of Hand Surgeons.Results All incisions healed well,and no nail infection and broken nail phenomenon were observed.In addition,mallet finger deformities were all corrected postoperatively.All 10 cases were followed up,and the follow-up period was 6 to 7.5 months.At the last follow-up,the mean active ROM of the distal interphalangeal joint was 28.8°-36.2°[30.2°(30.1°,33.2°)],and the mean TAM of the injured finger was 223.8°-236.3°[225.5°(225.1°,232.4°)].There was no significant difference in ROM and TAM between the injured finger and the healthy finger(Z=−4.66,−1.32;all P values>0.05).Based on the TAM system assessment criteria,seven cases were excellent;three cases were good.Conclusion A satisfactory therapeutic outcome for the treatment of bony mallet finger deformity can be achieved by the combination of

关 键 词：指骨 骨性锤状指 8字捆绑法 骨折内固定 修复重建 

分 类 号：R658.2[医药卫生—外科学]