摘要
目的评估应用指间关节松解术结合微型外固定装置治疗陈旧性近指间关节骨折伴背侧脱位的疗效。方法自2013年6月至2016年11月,我们采用指间关节松解术结合微型外固定装置治疗陈旧性近指间关节骨折伴背侧脱位患者11例,按Schenck分型:ⅠA型4例,ⅠB型2例,ⅡB型5例。术前指间关节功能按Ishida-Ikuta评分均评定为差。术中松解指浅屈肌腱止点粘连带,并将掌板近端做V形切开,新鲜化骨折端,松解近指间关节,使关节可被动屈伸达到正常范围,复位骨折,并用肌腱缝线修复掌板及副侧副韧带,固定骨折块后采用微型外固定装置牵开及维持关节间隙。术后4周去除外固定支架,开始进行近指间关节主被动屈伸功能锻炼。术后随访骨折愈合情况,并用Ishida-Ikuta评分进行功能评定。结果术后所有患者均获得完整随访,时间为7~24个月,平均13.1个月,切口均Ⅰ期愈合,无指神经损伤等并发症发生,其中1例出现针道感染,去除外固定装置、换药后愈合。术后X线片示所有病例骨折均完全愈合,时间为9~13周,平均10.3周。功能评价按Ishida-Ikuta评分:优10例,良1例。结论近指间关节松解术结合微型外固定装置治疗陈旧性近指间关节骨折伴背侧脱位疗效良好。
Objective To evaluate the clinical efficacy of micro external fixation device and arthrolysis for treatment of old proximal interphalangeal joint fracture with dorsal dislocation.Methods From June 2013 to November 2016,11 cases of old proximal interphalangeal joint fracture with dorsal dislocation were treated by interphalangeal joint release combined with micro external fixation device.According to Schenck′s classification,there were 4 cases of type ⅠA,2 cases of typeⅠB,and 5 cases of type ⅡB.The preoperative interphalangeal joint function was evaluated as poor according to the Ishida-Ikuta score.During the operation,the superficial flexor tendon of the finger was released and the proximal end of the volar plate was cut in a V-shape.The fracture end was freshened,and the interphalangeal joint was released to allow passive flexion and extension to reach the normal range.The fracture was reduced,and the volar plate and collateral ligament were repaired with tendon sutures.After fixing the fracture block,a micro external fixation device was used to retract and maintain the joint space.After 4 weeks of surgery,the external fixation device was removed and the active and passive flexion and extension exercise of the proximal interphalangeal joint began.The fracture healing was followed up after surgery and the function was evaluated using the Ishida-Ikuta score.Results All the patients received complete follow-up after surgery,ranging from 7 to 24 months,with an average of 13.1 months.The incisions achieved primary healing,and there were no complications such as finger nerve injury.Among them,one patient had a needle infection,which healed after removing the external fixation device and changing the dressing.The postoperative X-ray showed that all the fractures healed completely in all cases,with a time of 9 to 13 weeks,with an average of 10.3 weeks.According to Ishida-Ikuta score,the results were rated as excellent in 10 cases and good in 1 case.Conclusion The application of proximal interphalangeal joint release combined with micro external fixation device is effective in the treatment of old proximal interphalangeal joint fracture with dorsal dislocation.
作者
赵志明
李立全
何祥春
薛云皓
Zhao Zhiming;Li Liquan;He Xiangchun;Xue Yunhao(Department of Minimally Invasive Orthopedics,Suizhou Central Hospital,Suizhou 441300,China;Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华手外科杂志》
CSCD
北大核心
2024年第1期64-67,共4页
Chinese Journal of Hand Surgery
基金
湖北省自然科学基金项目(2022CFB002)。
关键词
骨折
脱位
近指间关节
外固定器
关节松解术
Fractures,bone
Dislocations
Proximal interphalangeal joint
External fixator
Arthrolysis
