儿童急性闭合性锤状指的诊断与非手术治疗
摘要
目的探讨儿童急性闭合性锤状指的诊断及其非手术治疗方法。方法回顾性分析自2010-01—2017-05诊治的21例儿童急性闭合性锤状指,采用低温热塑板从掌侧环绕拇指将患指固定在腕关节背伸15°～20°、掌指关节屈曲30°～40°、近指间关节屈曲50°～60°、远指间关节过伸5°～15°位。结果 21例均获得完整随访,随访时间平均13.5(6～24)个月。12例合并撕脱骨折患儿骨折块基本复位,3个月内均达骨性愈合,均无功能受限。患指近侧指间关节、掌指关节、腕关节及其他关节活动度均正常。患指远侧指间关节伸屈活动度:16例为0°～70°,4例为0°～60°,1例为0°～53°。将患指与健指远侧指间关节活动度比较,疗效根据TAM系统评定:优16例,良4例,可1例。结论对于儿童急性闭合性锤状指,因患儿骨骼发育未成熟、查体不配合等原因导致早期诊断较困难,需要临床医师仔细询问病史并结合查体及影像学检查准确诊断。采用掌侧改良支具固定非手术治疗儿童急性闭合性锤状指操作简单、疗效确切。
引文
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[2]Lubahn JD,Hood JM.Fractures of the distal interphalangeal joint[J].Clin Orthop Relat Res,1996,327:12-20.
[3]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(3):130-135.
[4]Forward KE,Yazdani A,Lim R.Mallet finger in a toddler:a rare but easily missed injury[J].Pediatr Emerg Care,2017,33(10):e103-e104.
[5]Ganayem M,Edelson G.Base of distal phalanx fracture in children:a mallet finger mimic[J].J Pediatr Orthop,2005,25(4):487-489.
[6]Al-Qattan MM.Extra-articular transverse fractures of the base of the distal phalanx(Seymour's fracture)in children and adults[J].JHand Surg Br,2001,26(3):201-206.
[7]Stern PJ.Fractures of the metacarpals and phalanges[M].In:Green DP,Hotchkiss RN,Pederson WC,eds.Green's operative hand surgery,Vol.Ⅰ.New York:Churchill Livingstone,1999:732-734.
[8]Bayne LG,Costas BL,Lourie GM.The upper limb[M].In:Morrissy RT,Weinstein SL,eds.Pediatric Orthopaedics,Vol.Ⅱ.Philadelphia:Lippincott-Raven,1996:828-831.
[9]周广良,蒋国栋,巨积辉,等.锤状指的治疗进展[J].实用手外科杂志,2013,27(2):166-168.
[10]王扬剑,魏鹏,王欣,等.石黑法治疗伴撕脱骨折锤状指的疗效[J].现代实用医学,2009,21(10):1132-1134.
[11]王辉,杨晓溪,王斌,等.改良抽出钢丝法治疗骨与肌腱同时损伤锤状指[J].中国骨与关节损伤杂志,2018,33(3):323-324.
[12]贾杰,魏智辉,陈伟,等.经骨隧道腱-骨缝合手术治疗腱性锤状指[J].中国骨与关节损伤杂志,2018,33(9):996-997.
[13]杭如群,张建华,霍双奎.新鲜闭合无骨折锤状指的手术治疗效果观察[J].中国煤炭工业医学杂志,2010,13(10):1478.
[14]潘勇卫,田光磊,李淳,等.改良支具固定治疗陈旧腱性锤状指[J].中华手外科杂志,2010,26(6):328-331.