骨性锤状指伸直支具固定与阻挡克氏针治疗效果的对比分析  

Comparative analysis of extension orthosis and extension pin block technique for bony mallet fingers

作　　者：卢飞旗 袁野[1] 李成利 段古满 邓玖征[1] 朱剑津[1] 何大炜[1] 潘勇卫[1] Feiqi Lu;Ye Yuan;Chengli Li;Guman Duan;Jiuzheng Deng;Jianjin Zhu;Dawei He;Yongwei Pan(School of Clinical Medicine,Tsinghua University,Department of Orthopaedic Trauma,Orthopaedics and Sports Medicine Center,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]清华大学临床医学院、北京清华长庚医院骨科与运动医学中心创伤骨科,102218

出　　处：《中华损伤与修复杂志（电子版）》2024年第3期245-250,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的伴关节脱位的骨性锤状指一般采用手术治疗,保守治疗的相关研究较少。通过分析伸直支具固定治疗骨性锤状指的疗效,并与同期采用石黑法固定的患者相比较,为临床治疗提供指导。方法回顾性分析2015年3月至2021年9月北京清华长庚医院创伤骨科采用支具治疗的19例末节指骨背侧撕脱骨折导致骨性锤状指患者资料,收集同期采用石黑法手术治疗的29例患者资料,对比两组骨折和关节复位情况、患指关节主动屈伸角度、患/健侧活动度占比、Dargan功能评定、并发症等指标。结果支具固定组患指远指间关节(DIPJ)伸直欠缺角度0 °~15 °(4.68±5.00)°,手术组为0 °~12 °(3.14±4.16)°,两组间差异无统计学意义(P=0.32);支具固定组主动屈曲角度38 °~60 °(50.42±6.73)°,手术组为35 °~62 °(48.38±7.49)°,两组间差异无统计学意义(P=0.34);患/健侧活动度占比支具固定组为(0.74±0.14),手术组为(0.76±0.13),两组差异无统计学意义(P=0.85);Dargan功能评价手术组优17例,良12例。支具固定组:优10例,良9例,两组比较差异均无统计学意义(P=0.77)。支具固定组并发症发生率47.3%,手术组为44.8%,两组间差异无统计学意义(P>0.05)。结论骨性锤状指支具固定与手术治疗短期疗效相当,并发症发生率相当,但手术治疗并发症一旦发生,多较严重,且可能为永久性;支具固定需要关注患者的依从性,才能取得较好结果。保守治疗对于一些选择恰当的患者,有其治疗价值。ObjectiveBony mallet fingers are generally treated with surgery, and there are few reports on conservative treatment. This study retrospectively analyzed the efficacy of the molded polythene splint for bony mallet finger deformities, providing guidance for clinical treatment.MethodsA retrospective analysis was conducted on 19 patients with distal phalangeal dorsal avulsion fractures resulting in bony mallet fingers treated with splint in Department of Orthopedic Trauma, Beijing Tsinghua Changgung Hospital from March 2015 to September 2021.As a comparison, 29 patients who underwent surgical treatment with Ishiguro′s technique during the same period were collected, and the fracture and joint reduction, active flexion and extension angle of affected finger joint, Dargan function evaluation, complication rate were compared between the two groups.ResultsThe average DIPJ extensor lag was 0 °~15 °(4.68 ± 5.00)° in the splinting group and 0 °~12 °(3.14 ± 4.16 )° in the surgical group. There was no significant difference between the two groups(P=0.32). Active flexion angle was 38 °~60 ° (50.42±6.73)° in the splinting group and 35 °~62 °(48.38±7.49)° in the surgical group. There was no significant difference between the two groups(P=0.34). The proportion of affected/healthy side range of motion was (0.74±0.14) in the splinting group and (0.76 ± 0.13) in the surgical group. There was no significant difference between the two groups(P=0.85). 10 were excellent and 9 were good in splinting group on dargan function evaluation and 17 cases were excellent, and 12 cases were good in the surgical group. There was no significant difference between the two groups(P=0.77). The incidence of complications was 47.3% in the splinting group and 44.8% in the surgical group. There was no significant difference between the two groups(P>0.05).ConclusionThe short-term effect of surgical treatment of bony mallet finger is equivalent to that of splinting, and the incidence of complications is the same, but once the complicatio

关 键 词：骨性锤状指 外科手术 支具固定 石黑法 

分 类 号：R68[医药卫生—骨科学]