双“8”字捆绑联合双克氏针在陈旧性骨性锤状指中的临床应用  

Clinical application of bundling bone fragments with double figure-of-eight suture combined with double Kirschner wire in bony mallet finger

作　　者：江起庭 姚翔 何兵 邱福平 程健 王斌 杨玲玲 Jiang Qiting;Yao Xiang;He Bing;Qiu Fuping;Cheng Jian;Wang Bin;Yang Lingling(Department of Hand and Foot Microsurgery,Nanjing Jiangbei Hospital,Nanjiang 210048,China)

机构地区：[1]南京江北医院手足显微外科,南京210048

出　　处：《中华临床医师杂志（电子版）》2024年第1期24-29,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨双“8”字捆绑联合双克氏针在陈旧性骨性锤状指中的临床疗效。方法回顾性分析2021年6月至2023年5月南京江北医院手足显微外科收治的24例(指)陈旧性骨性锤状指患者临床资料,缝线双“8”字形捆绑骨块于末节指骨基底部。6周拔除克氏针后逐步加强患指伸屈运动,测量患指及各关节的主动屈伸活动范围,记录手指总的主动活动度(TAM)及远指间关节活动度(ROM);参照美国手外科协会TAM系统评定手指功能。结果共纳入24例(24指),男性14例,女性10例,年龄16~54岁。根据Wehbe和Schneider分型:Ⅰ:a型5例,b型5例;Ⅱ:a型8例,b型4例;Ⅲ:a型1例,b型1例。受伤至手术时间21~64 d。切口一期愈合,无断针及脱针现象。骨折处均对位可愈合佳,锤状指畸形均完全矫正。24例患指术后获随访,随访时间为6.0~9.3个月。末次随访患指的远指间关节ROM为28.5°~39.2°[31.5°(31.1°,33.7°)],与对应健指的远指间关节ROM为30.6°~40.2°[31.8°(32.°1,35.2°)]比较无统计学意义(Z=-3.92,P=0.724);患指TAM为229.4°~238.5[°232.2(°230.8°,234.5°)]与对应健指的TAM为230.2°~241.3[°234.1(°233.5°,235.7°)],差异无统计学意义(Z=-1.84,P=0.314)。以TAM系统评定标准:优21例,良3例,优良率为100%。结论缝线双“8”字捆绑骨块联合双克氏针,固定牢固且持久,能有效治疗陈旧性骨性锤状指,是一种实用而简便的方法。Objective To assess the clinical curative effect of bundling bone fragments with double figure-of-eight suture in bony mallet finger.Methods A retrospective analysis was performed on 24 patients(24 fingers)with chronic bony mallet finger who underwent surgery at the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from June 2021 to May 2023.During the procedure,bundling bone fragment with double figure-of-eight suture was performed on the base of the distal phalanx.After removal of the Kirschner wire at postoperative 6 weeks,the flexion and extension of the affected finger were gradually strengthened,the range of motion(ROM)and the total active range of motion(TAM)of the finger were recorded.Finger function was evaluated according to the TAM system of the American Association of Hand Surgeons.Results A total of 24 patients were enrolled,including 14 males and 10 females,and the age ranged from 16 to 54 years old.According to the Wehbe and Schneider classification,there were 5 cases of type Ia,5 cases of type Ib,8 cases of type IIa,4 cases of type IIb,1 cases of typeⅢa,and 1 cases of typeⅢb.The range of time from injury to operation was 21 days to 64 days.All incisions healed well,with no broken nail and no shedding nail.Mallet finger deformities were all corrected postoperatively,and all fractures healed well.All the 24 cases were followed,and the follow-up period was 6.0 to 9.3 months.At the last follow-up,the mean active ROM of the distal interphalangeal joint of the injured finger was 28.5°~39.2°[31.5°(31.1°,33.7°)],and the mean active ROM of the distal interphalangeal joint of the healthy finger was 30.6°~40.2°[31.8°(32.°1,35.2°)].There was no significant difference in ROM between the injured finger and the healthy finger(Z=-3.92,P=0.724).The TAM of the injured finger was 229.4°~238.5°[232.2°(230.8°,234.5°)],and that of the healthy finger was 230.2°~241.3°[234.1°(233.5°,235.7°)].There was no significant difference in TAM between the injured finger and the healthy f

关 键 词：指损伤 “8”字捆绑 锤状指 骨折固定术 内 

分 类 号：R658.2[医药卫生—外科学]