闭合复位髓内针与交叉克氏针内固定治疗掌骨颈骨折的疗效对比

摘要

目的 比较闭合复位顺行髓内针内同定与交叉克氏针内固定治疗掌骨颈骨折的疗效.方法 自2013年3月至2016年3月我院治疗85例掌骨颈骨折患者,其中应用闭合复位顺行髓内针固定49例(髓内针组),应用闭合复位交叉克氏针固定36例(克氏针组),两组病例均由同一位医生完成,术后予相同的功能锻炼指导.术后10个月作为评价手功能时间,应用美国手外科协会TAFS系统评价手功能.结果 术后85例患者随访10～16个月,平均12个月.骨折愈合时间两组各有l例为10周,其余83例为6～8周,其中髓内针组骨折平均愈合时间为(6.2±2.4)周,克氏针组骨折平均愈合时间为(6.3±1.9)周,骨折愈合时间差异无统计学意义(p＞0.05).术后10个月两组手功能TAFS评分:髓内针组优39例,良7例,可3例,优良率93.9％;克氏针组优16例,良14例,可6例,优良率83.3％;髓内针组优于克氏针组,两组优良率差异有统计学意义(P＜0.05).结论 闭合复位髓内针治疗掌骨颈骨折操作简单,创伤小,对患者术后手部功能锻炼影响小,手部功能恢复评分较克氏针组为优.%Objective To compare the clinical efficacy of close reduction internal fixation with intramedullary pin and cross Kirschner wires in the treatment of metacarpal neck fractures.Methods From March 2013 to March 2016,85 cases of metacarpal neck fractures were treated in our hospital.Close reduction internal fixation with intramedullary pin was conducted in 49 cases (intramedullary pin group) and with cross Kirschner wires in 36 cases (Kirschner wire group).Both groups were performed by the same surgeon.After the operation the same functional exercise instruction was given.The hand function was evaluated by the TAFS system issued by American Hand Surgery Association 10 months after the operation.Results All the patients were follow-up for 10 to 16 months with an average of 12 months.The fracture healing time was 10 weeks in one case from each of the two groups,and 6 to 8 weeks in the other 83 cases.The average healing time was (6.2 +2.4) weeks from the intramedullary pin group and (6.3 +1.9) weeks from the Kirschner wire group.There was no significant difference in the healing time between the two groups (P＞0.05).TAFS scores of hand function were excellent in 39 cases,good in 7 cases,fair in 3 cases with the excellent and good rate being 93.9％ from the intramedullary pin group;while they were excellent in 16 cases,good in 14 cases,fair in 6 cases with the excellent and good rate being 83.3％ from the Kirschner wire group 10 months after the operation.The results from the intramedullary pin group were better than those from the Kirschner wire group.The difference was statistically significant (P＜0.05).Conclusion The close reduction internal fixation with intramedullary pin for the treatment of metacarpal neck fractures is a simple method with small trauma.It has little effect on hand function exercise after the operation.The score of hand function recovery is better than that of Kirschner wire group.