手部自制克氏针-橡皮筋可活动型外固定牵引架治疗近节指间关节骨折脱位的疗效评价
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摘要
目的:观察并评价手部自制克氏针-橡皮筋可活动型外固定牵引架在近节指间关节骨折脱位中的治疗作用。方法:选择2015年1月-2016年1月在本院治疗的近节指间关节骨折脱位患者60例,均采用手部自制克氏针-橡皮筋可活动型外固定牵引架治疗。比较所有患者手术前后Michigan手功能问卷表(MHQ)评分、患侧握力占健侧比及关节活动度的差异,并进行术后随访,观察所有患者的骨折愈合情况、并发症情况及手部运动功能恢复情况。结果:对60例患者进行平均(16.84±5.25)个月的随访,术后平均(6.43±1.38)周所有患者均拆除了外固定支架,并经X线复查显示,所有骨折均呈骨性愈合,指间关节无侧偏及分离,平均愈合时间为(12.47±3.21)周,且复位满意,未见骨性不愈合及针道感染等并发症发生。术后TAM疗效,其中优31例,良18例,可8例,差3例,优良率为81.67%。术后,患者的平均MHQ评分、患侧握力占健侧比及关节活动度均明显优于术前,差异均有统计学意义(P<0.05)。结论:手部自制克氏针-橡皮筋可活动型外固定牵引架治疗近节指间关节骨折脱位效果较理想,有助于骨折固定及术后手指早期功能康复,故提倡使用推广。
Objective:To observe and evaluate the effect of self-made Kirschner's needle and rubber band movable external distraction fixator in the treatment of fracture dislocation of proximal interphalangeal joint.Method:A total of 60 cases with fracture dislocation of proximal interphalangeal joint in our hospital from January 2015 to January 2016 were given the self-made Kirschner's needle and rubber band movable external distraction fixator.MHQ score,ratio of the affected side to the healthy side and the difference of joint activity of all patients before and after surgery were compared,and were followed up after operation,and the fracture healing, complications and hand motor function recovery of all patients were observed.Result:All patients were followed up for an average of(16.84±5.25)months,and were dismantled the external fixation stents after operation for average of(6.43±1.38)weeks and were examined by X-ray examination.All fractures showed bony union,and there was no lateral deviation and separation of the interphalangeal joints,and the average healing time was(12.47±3.21)weeks,and all the fractures were satisfactory.There was no bone nonunion and pin tract infection occurred.The clinical effect of TAM after operation,which 31 cases were excellent,18 cases were good,8 cases were good,and 3 cases were poor,and the good rate was 81.67%.After the operation,the average MHQ score,the side grip strength of the affected side and the joint activity were significantly better than those of before operation,the differences were statistically significant(P<0.05).Conclusion:The effect of self-made Kirschner's needle and rubber band movable external distraction fixator in the treatment of fracture dislocation of proximal interphalangeal joint are ideal,which it is helpful to the fixation of fracture and the rehabilitation of the early function of the fingers.Therefore,it is worthy to be used and promoted.
Objective:To observe and evaluate the effect of self-made Kirschner's needle and rubber band movable external distraction fixator in the treatment of fracture dislocation of proximal interphalangeal joint.Method:A total of 60 cases with fracture dislocation of proximal interphalangeal joint in our hospital from January 2015 to January 2016 were given the self-made Kirschner's needle and rubber band movable external distraction fixator.MHQ score,ratio of the affected side to the healthy side and the difference of joint activity of all patients before and after surgery were compared,and were followed up after operation,and the fracture healing, complications and hand motor function recovery of all patients were observed.Result:All patients were followed up for an average of(16.84±5.25)months,and were dismantled the external fixation stents after operation for average of(6.43±1.38)weeks and were examined by X-ray examination.All fractures showed bony union,and there was no lateral deviation and separation of the interphalangeal joints,and the average healing time was(12.47±3.21)weeks,and all the fractures were satisfactory.There was no bone nonunion and pin tract infection occurred.The clinical effect of TAM after operation,which 31 cases were excellent,18 cases were good,8 cases were good,and 3 cases were poor,and the good rate was 81.67%.After the operation,the average MHQ score,the side grip strength of the affected side and the joint activity were significantly better than those of before operation,the differences were statistically significant(P<0.05).Conclusion:The effect of self-made Kirschner's needle and rubber band movable external distraction fixator in the treatment of fracture dislocation of proximal interphalangeal joint are ideal,which it is helpful to the fixation of fracture and the rehabilitation of the early function of the fingers.Therefore,it is worthy to be used and promoted.
引文
[1]刘坤,武竞衡,陈山林,等.近端指间关节骨折脱位患者的动态牵引联合切开复位内固定治疗[J].中国骨与关节杂志,2017,6(4):258-261.
[2]项杰,陈肖肖,蔡国平,等.克氏针外固定牵引架在治疗近节指间关节骨折脱位中的应用[J].医学研究杂志,2015,44(7):132-135.
[3]余湘,邢丹谋,冯伟.关节松解术联合中药熏洗治疗外伤性近指间关节僵硬[J].中华实验外科杂志,2017,34(3):455.
[4]Maitland F W,Chaytor A H.Complications following dislocations of the proximal interphalangeal joint[J].J Bone Joint Surg Am,2013,95(14):1326-1332.
[5]纪秉青.30例手指皮肤脱套伤再植术后随访结果及其评价[D].扬州:扬州大学,2016.
[6]黄鹤.近排腕骨切除术后对腕关节功能影响的临床疗效分析[D].石家庄:河北医科大学,2015.
[7]王承利,陆九州,方有生,等.自制简易外固定牵引支架结合克氏针固定治疗近中节指骨干粉碎性骨折[J].实用手外科杂志,2014,28(2):171-173.
[8]白印伟,张振伟,李征,等.手术复位内固定加动态牵引克氏针外固定架治疗近指间关节内骨折[J].实用手外科杂志,2015,29(4):383-386.
[9]李盛州,吴可晚,谢路,等.改良双克氏针髓内固定法治疗近节指骨基底部关节外骨折[J].中国修复重建外科杂志,2016,30(8):935-938.
[10]疏建.切开复位内固定和闭合复位内固定治疗Lisfranc损伤疗效比较[D].太原:山西医科大学,2014.
[11]骆渊城,王晶,敖传西,等.闭合复位与切开复位内固定治疗跖跗关节损伤的效果比较[J].中国医药导报,2017,14(3):102-105.
[12]项杰,陈肖肖,蔡国平,等.克氏针外固定牵引架在治疗近节指间关节骨折脱位中的应用[J].医学研究杂志,2015,44(7):132-135.
[13]王华柱,田文,赵建勇.近侧指间关节骨折脱位的治疗进展[J].实用手外科杂志,2016,30(1):80-82.
[14]吴奇剑.胫骨Pilon骨折的治疗演变及研究进展[J].中国药物与临床,2013,13(9):1171-1173.
[15]王浩,李连华,彭城,等.不同内固定方式治疗胫骨后pilon骨折的疗效分析[J].中华创伤骨科杂志,2016,18(6):481-486.
[16]刘坤,陈仲强,熊革,等.一种新型动态牵引外固定架治疗近指问关节骨折脱位的实验研究[J].中华手外科杂志,2014,30(3):212-215.
[17]Suzuki Y,Matsunaga T,Sato S,et al.The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand[J].J Hand Surg Br,1994,19(1):98-107.
[18]缪道一,杨国敬,张凌洲,等.动态牵引支架结合有限内固定与克氏针内固定治疗近指间关节Pilon骨折的病例对照研究[J].中国骨伤,2015,28(10):920-923.
[19]Goldberg E,Unglaub F,Kneser U,et al.Intraarticular fractures of the proximal interphalangeal joint[J].Unfallchirurg,2009,112(3):337-345.
[2]项杰,陈肖肖,蔡国平,等.克氏针外固定牵引架在治疗近节指间关节骨折脱位中的应用[J].医学研究杂志,2015,44(7):132-135.
[3]余湘,邢丹谋,冯伟.关节松解术联合中药熏洗治疗外伤性近指间关节僵硬[J].中华实验外科杂志,2017,34(3):455.
[4]Maitland F W,Chaytor A H.Complications following dislocations of the proximal interphalangeal joint[J].J Bone Joint Surg Am,2013,95(14):1326-1332.
[5]纪秉青.30例手指皮肤脱套伤再植术后随访结果及其评价[D].扬州:扬州大学,2016.
[6]黄鹤.近排腕骨切除术后对腕关节功能影响的临床疗效分析[D].石家庄:河北医科大学,2015.
[7]王承利,陆九州,方有生,等.自制简易外固定牵引支架结合克氏针固定治疗近中节指骨干粉碎性骨折[J].实用手外科杂志,2014,28(2):171-173.
[8]白印伟,张振伟,李征,等.手术复位内固定加动态牵引克氏针外固定架治疗近指间关节内骨折[J].实用手外科杂志,2015,29(4):383-386.
[9]李盛州,吴可晚,谢路,等.改良双克氏针髓内固定法治疗近节指骨基底部关节外骨折[J].中国修复重建外科杂志,2016,30(8):935-938.
[10]疏建.切开复位内固定和闭合复位内固定治疗Lisfranc损伤疗效比较[D].太原:山西医科大学,2014.
[11]骆渊城,王晶,敖传西,等.闭合复位与切开复位内固定治疗跖跗关节损伤的效果比较[J].中国医药导报,2017,14(3):102-105.
[12]项杰,陈肖肖,蔡国平,等.克氏针外固定牵引架在治疗近节指间关节骨折脱位中的应用[J].医学研究杂志,2015,44(7):132-135.
[13]王华柱,田文,赵建勇.近侧指间关节骨折脱位的治疗进展[J].实用手外科杂志,2016,30(1):80-82.
[14]吴奇剑.胫骨Pilon骨折的治疗演变及研究进展[J].中国药物与临床,2013,13(9):1171-1173.
[15]王浩,李连华,彭城,等.不同内固定方式治疗胫骨后pilon骨折的疗效分析[J].中华创伤骨科杂志,2016,18(6):481-486.
[16]刘坤,陈仲强,熊革,等.一种新型动态牵引外固定架治疗近指问关节骨折脱位的实验研究[J].中华手外科杂志,2014,30(3):212-215.
[17]Suzuki Y,Matsunaga T,Sato S,et al.The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand[J].J Hand Surg Br,1994,19(1):98-107.
[18]缪道一,杨国敬,张凌洲,等.动态牵引支架结合有限内固定与克氏针内固定治疗近指间关节Pilon骨折的病例对照研究[J].中国骨伤,2015,28(10):920-923.
[19]Goldberg E,Unglaub F,Kneser U,et al.Intraarticular fractures of the proximal interphalangeal joint[J].Unfallchirurg,2009,112(3):337-345.