切开复位钩状钢板固定与闭合间接复位背侧伸直阻挡克氏针固定治疗骨性锤状指的临床疗效对比研究  

Effectiveness comparison of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet finger

作　　者：赵文韬 赵民 ZHAO Wentao;ZHAO Min(Department of Orthopedics,Beijing Shunyi District Hospital,Beijing,101300,P.R.China)

机构地区：[1]北京市顺义区医院骨科,北京101300

出　　处：《中国修复重建外科杂志》2024年第8期981-986,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较切开复位钩状钢板固定与闭合间接复位背侧伸直阻挡克氏针固定治疗骨性锤状指的临床疗效。方法回顾分析2019年5月—2022年6月收治且符合选择标准的68例骨性锤状指患者临床资料。其中切开组33例(采用切开复位钩状钢板固定),闭合组35例(采用闭合间接复位背侧伸直阻挡克氏针固定治疗)。两组患者性别、年龄、患侧侧别、伤指指别、致伤原因、受伤至手术时间及Wehbé-Schneider分型比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中透视次数、骨折愈合时间、返岗工作时间及并发症发生情况;术后12个月采用疼痛视觉模拟评分(VAS)评定伤指疼痛情况,量角器测量手指远侧指间关节(distal interphalangeal joint,DIP)主动屈曲活动度及伸直欠缺度,采用Crawford标准评定临床疗效。结果两组患者均获随访,随访时间12~26个月,平均15个月;闭合组和切开组随访时间比较差异无统计学意义(P>0.05)。闭合组手术时间短于切开组,术中透视次数、骨折愈合时间及返岗工作时间均多于切开组,差异均有统计学意义(P<0.05)。闭合组发生针道感染5例、末节指背侧皮肤小面积压疮坏死3例,经加强护理换药后痊愈;切开组发生7例指甲局部凹陷畸形,拆除内固定钢板后畸形消失;其余患者切口均顺利愈合,无感染、皮肤坏死、内固定物外露、指甲畸形等并发症发生。两组患者皮肤坏死发生率比较差异无统计学意义(P>0.05),感染和指甲畸形发生率比较差异有统计学意义(P<0.05)。术后12个月,两组VAS评分、DIP主动屈曲活动度、DIP伸直欠缺度及Crawford标准评价比较差异均无统计学意义(P>0.05)。末次随访时两组患者均无DIP骨关节炎及关节退行性改变发生。结论切开复位钩状钢板固定与闭合间接复位背侧伸直阻挡克氏针固定治疗骨性锤状指虽各有利弊,但均取得了较好治疗效果;�Objective To compare the effectiveness of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet fingers.Methods The clinical data of 68 patients with bony mallet finger who admitted between May 2019 and June 2022 were retrospectively analyzed.Among them,33 cases were in the open group(treated with open reduction and hook plate fixation)and 35 cases were in the closed group(treated with closed indirect reduction and dorsal extension blocking Kirschner wire fixation).There was no significant difference between the two groups in terms of gender,age,the affected side,the affected finger,cause of injury,time from injury to operation,and Wehbé-Schneider classification(P>0.05).The operation time,intraoperative fluoroscopy frequency,fracture healing time,time of returning to work,and postoperative complications were recorded and compared between the two groups.At 12 months after operation,visual analogue scale(VAS)score was used to assess the pain of the injured finger,active flexion range of motion and extension deficit of the distal interphalangeal joint(DIP)were measured by goniometer,and the effectiveness was assessed by Crawford criteria.Results All patients in the two groups were followed up 12-26 months,with an average of 15 months.There was no significant difference in the follow-up time between the closed group and the open group(P>0.05).The operation time in the closed group was shorter than that in the open group,and the intraoperative fluoroscopy times,the fracture healing time,and the time of returning to work in the closed group were more than those in the open group,and the differences were significant(P<0.05).In the closed group,there were 5 cases of pinning tract infection and 3 cases of small area pressure ulcer skin necrosis on the dorsal side of the finger,which were cured after intensive nursing and dressing change.Local nail depression deformity occurred in 7 cases in the open group,and the deformity disappeared

关 键 词：骨性锤状指 闭合复位 切开复位 钢板 克氏针 

分 类 号：R687.3[医药卫生—骨科学]