应用两种方法治疗压砸伤所致中节指骨双髁骨折的临床对比研究

摘要

Objective To compare and analyze the clinical results of two treatment techniques in managing bicondylar fractures of the middle phalahx caused by crush injury.Methods Crush injury induced bicondylar fractures of the middle phalanx with displacement that were treated between March 2011 and June 2013 were retrospectively reviewed.Dynamic external fixation combined with limited internal fixation were used in 16 cases (Group A),while close reluction and internal fixation with Kirschner wire combined with finger splint were used in 13 cases (Group B).The clinical outcomes were evaluated by the total active motion (TAM) at the last follow-up.Results The patients in group A were follow-up for 5.1 to 10.3 months,with an average of 7.9 months.The patients in group B were follow-up for 5.4 to 9.9 months,with an average of 7.7 months.There was no difference between the two groups regarding follow-up duration (P ＞ 0.05).According to the functional assessment criteria for upper extremities issued by the Hand Surgery Society of the Chinese Medical Association,the results in group A were graded as excellent in 9 cases,good in 5 cases,fair in 1 case and poor in 1 case with a good and excellent rate of 87.5％.In group B the results were graded as excellent in 2 cases,good in 4 cases,fair in 5 cases and poor in 2 cases with a good and excellent rate of 46.2％.The difference between the two groups was significant (P ＜ 0.05).Conclusion Dynamic external fixation with limited internal fixation can obtain reliable fixation of bicondylar fractures of the middle phalanx,maintain the traction and permit early mobilization of the joint.It is a more ideal option for treating intra-articular fractures.%目的 应用两种不同的方法治疗中节指骨双髁开放性骨折,对治疗结果进行比较分析.方法 2011年3月至2013年6月应用动力性外固定结合有限内固定治疗由压砸伤所致有移位的中节指骨双髁骨折患者16例(A组),应用闭合复位克氏针内固定结合铝板外固定治疗13例(B组),对两种方法进行比较分析.结果 A组随访时间为5.1～ 10.3个月,平均7.9个月;B组随访时间为5.4～9.9个月,平均7.7个月.随访时间两组比较差异无统计学意义(P＞0.05).最后一次随访测量记录患指关节总活动度(TAM).按照中华医学会手外科学会手部功能评定标准评定:A组优9例,良5例,中1例,差1例,优良率87.5％;B组优2例,良4例,中5例,差2例,优良率46.2％.两组比较差异有统计学意义(P＜0.05).结论 动力性外固定结合有限内固定可对中节指骨双髁骨折进行有效固定,并维持关节牵引,允许关节早期活动,是一种更为理想的治疗关节内骨折的方法.