两种急诊内固定手术方案治疗掌指骨开放性骨折临床对比研究-现代医学

两种急诊内固定手术方案治疗掌指骨开放性骨折临床对比研究

作者：吴平

单位：马鞍山市中心医院急诊中心创伤组, 安徽马鞍山 243000

分类号：R638.41

出版年·卷·期（页码）：2017·36·第十一期（1633-1636）

摘要：

目的：对比研究两种急诊内固定手术方案治疗掌指骨开放性骨折的临床效果。方法：选择2012年1月至2017年1月在本院就诊的60例掌指骨开放性骨折患者，按照随机数字表法将患者分为克氏针组和微钢板组，各30例。微钢板组患者采用微钢板内固定手术，克氏针组采用穿髓内固定术治疗，记录两组患者的手术时间、住院时间、骨折愈合时间、恢复工作时间。观测患者手指关节总体活动度，采用电子握力计测量并记录患者的握力相比健侧丢失度，对患者的指功能优良率进行评定，记录两组患者并发症发生情况，如感染、骨延迟愈合、骨不连等。结果：微钢板组患者住院时间、恢复工作时间、骨折愈合时间均显著短于克氏针组，而手术时间长于克氏针组，差异均有统计学意义（P<0.05）；微钢板组患者握力相比健侧丢失度、手指关节总体活动度显著低于克氏针组，差异有统计学意义（P<0.05）；微钢板组功能优良率为93.33%，克氏针组功能优良率为73.33%，差异有统计学意义（P<0.05）；微钢板组患者并发症发生率为3.33%，克氏针组并发症发生率为23.33%，差异有统计学意义（P<0.05）。结论：微型钢板内固定治疗掌指骨开放性骨折牢固性较好，允许早期功能锻炼，并发症发生率较低，疗效、安全性均显著优于克氏针。

Objective:To compare the clinical effects of two emergent internal fixation schemes for open metacarpal and phalanx fractures. Methods:From January 2012 to January 2017, 60 patients with open fracture of metacarpal and phalanx were treated in our hospital. The patients were divided into Kirschner wire group and micro plate group according to the random number table, 30 in each. The patients in the micro plate group were treated with micro plate internal fixation, and the Kirschner wire group was treated with intramedullary fixation. The operation time, hospitalization time, fracture healing time and recovery time were recorded in the two groups. The overall activity of finger joint was observed; grip strength was measured using electronic dynamometer and compared to contralateral loss. Functional recovery, complications, such as infection, delayed union and nonunion were recorded. Results:In the micro plate group, hospitalization time, recovery time, fracture healing time was significantly less than that in the Kirschner wire group; in the Kirschner wire group, operation time was shorter than that of the mini plate group(P<0.05). In the micro plate groupthe contralateral loss of grip and finger joint overall activity were significantly lower than those of the Kirschner wire group(P<0.05). Micro platel group had a good function rate of93.33%, significantly higher than 73.33% of Kirschner wire group(P<0.05).Micro plate group had a complication rate of 3.33%, Kirschner wire group 23.33%, the two being significantly different. (P<0.05). Conclusion:Mini plate internal fixation for open metacarpal and phalangeal fractures is a good fixation method, which allows early functional exercise, low complication rate, better efficacy and safety than Kirschner wire.

参考文献：

[1] BASAR H,BASCI B,BASCI O,et al.Comparison of treatment of oblique and spiral metacarpal and phalangeal fracture with mini palte plus screw or screw only[J].Arch Orthop Trauma Sur,2015,135(4):499-504.
[2] McDONALD L S,SHUPE P G,HAMMEL N,et al.The intermetacarpal angle screening test for ulnar-sided carpometacarpal fracture-dislocations[J].J Hand Surg Am,2012,37(9):1839-1844.
[3] 徐海栋,陈勇,陆萌,等.掌指骨骨折3种不同治疗方法比较研究[J].医学研究生学报,2012,25(10):1045-1047.
[4] SIMPSON-WHITE R W,CHOJNOWSKI A J.Pyrocarbon metacarpophalangeal joint replacement in primary osteoarthritis[J].J Hand Surg Eur Vol,2014,39(6):575-581.
[5] 潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16:130-135.
[6] 黄昱,陈禄,杨俊贵,等.掌指骨骨折的不同手术方法临床效果对比[J].河北医学,2017,23(1):160-162.
[7] 岳勇,赵东风,孙皓,等.无头加压螺钉与微型钢板治疗掌、指骨骨折的疗效对比[J].临床军医杂志,2015,43(5):479-482.
[8] HARI K S,MAX K,TOM J J,et al.A biomechanical study on variation of compressive force along the Acutrak 2 screw[J].Injury,2012,43(2):205-208.
[9] 顾小华,殷磊,洪潮,等.微型钢板螺钉内固定结合康复治疗掌指骨多发性骨折[J].中国医师杂志,2014(增刊下册):76-77.
[10] 田建,芮永军,糜菁熠,等.微型外固定支架结合有限内固定治疗开放性粉碎性掌指骨骨折[J].中华手外科杂志,2013,29(1):4-6.
[11] 刘继敏.细钢丝、微型板内固定治疗掌指骨斜形、螺旋形骨折的比较观察[J].河北医药,2015,37(14):2148-2150.
[12] 罗洪斌.微型钢板置入内固定修复掌骨复杂骨折:优于克氏针的理由[J].中国组织工程研究,2015,19(35):5691-5696.
[13] 李刚,杜新辉.微型钢板与螺钉内固定治疗掌指骨斜形骨折疗效观察[J].重庆医学,2017,46(12):1678-1680
[14] KIM B S,YOON H G,PARK K H,et al.Sesamoidectomy and volar plate repair using suture anchor for hyperextension injury of themetacarpophalangeal joint of the thumb[J].Hand Surg,2013,18(2):287-295.
[15] BARR C,BEHN A W,YAO J.Plating of metacarpal fractures-withlockedor nonlocked screws,a biomechanical study:how many cortices are really necessary[J].Hand,2013,8(4):454-459.
[16] XU J,ZHANG C.Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population:a meta-analysis[J].J Orthop Surg Res,2014,9(3):24.
[17] BARR C,BEHN A W,YAO J.Plating of metacarpal fractures with locked or nonlocked screws,a biomechanical study:how many cortices are really necessary[J].Hand(NY),2013,8(4):454-459.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录