目的 介绍应用微型钢板联合克氏针治疗Mallet骨折的手术方法及疗效。方法 2014年1月—2016年1月,应用微型钢板联合克氏针治疗11例Mallet骨折患者,术中采用远侧指间(DIP)关节背侧“S”形或“L”形切口暴露骨折端,直视下复位骨折块后用微型钢板内固定骨折端,一枚克氏针外固定DIP关节。术后4～6周拔除克氏针,加强DIP关节功能锻炼。结果 所有患者术后行6～24个月随访,平均(15±6)个月,骨折均顺利愈合,愈合时间平均(5.5±1.5)周。术后DIP关节按Crawford功能评定方法评定:优5例,良4例,可2例。1例患者指甲出现轻微隆起,无关节炎、感染及内固定失效等并发症。结论 应用微型钢板联合克氏针治疗Mallet骨折,既保留了钢板治疗的优势,又增加了骨折端稳定性,治疗效果满意。
Objective To introduce the surgical technique and clinical outcome of treatment of Mallet fractures using hook plate combined with K-wire.Method From January 2014 to January 2016, 11 cases of Mallet fractures were treated with hook plate combined with K-wire. A dorsal S or L shaped incision was made at the distal interphalangeal (DIP) joint to expose the fracture site. Under direct visualization the fracture was reduced and fixed with mini hook plate, then use a K-wire to fix the DIP joint. The K-wire was extracted and DIP joint functional exercise was strengthened 4 to 6 weeks after operation.Results All the 11 cases were followed-up for 6 to 24 months with an average of (15±6) months. All the fractures healed successfully with an average of (5.5±1.5)weeks. Based on Crawford’s evaluation criteria of DIP joints, the results were excellent for 5 cases, good for 4 cases, and fair for 2 cases. Raised ridge of nail was seen in 1 case.There were no arthritis, infection, intemal fixation failure, and other complications.Conclusion The application of hook plate combined with K-wire technique in the treatment of Mallet fractures not only retains the advantages of plate treatment, but also increases the stability of fracture site, showing satisfactory treatment effect.
[1] 徐海林,傅中国,王天兵,等.锤状指的治疗[J].中华手外科杂志,2007,23(2):87-88.
[2] 付吉东,王立波,李敏,等.双克氏针内固定治疗指伸肌腱止点撕脱骨折[J].中华手外科杂志,2012,28(5):292-293.
[3] Crawford GP.The molded polythene splint for mallet finger deformities[J].J Hand Surg(Am),1984,9(2):231-237.
[4] 张文龙,张云鹏,张净宇,等.克氏针弹性固定技术治疗Mallet骨折[J].中华手外科杂志,2016,32(2):120-122.
[5] Toker S, Tiirkmen F, Pekince O, et al.Extension block pinning versus hook plate fixation for treatment of mallet fractures[J].J Hand Surg (Am),2015,40(8):1591-1596.
[6] Teoh LC, Lee JY.Mallet fractures:a novel approach to internal fixation using a hook plate[J].J Hand Surg Eur,2007,32(1):24-30.
[7] 李忠哲,易传军,胡琪,等.应用钩钢板内固定技术治疗mallet骨折[J].中华手外科杂志,2009,25(4):227-229.
[8] 吴志鹏,林大木,陈星隆,等.应用微型钩钢板治疗骨性锤状指的临床研究[J].中华手外科杂志,2015,31(1):9-11.
[9] Tie J, Hsieh MKH, Tay SC. Outcome of hook plate fixation of mallet fractures[J].J Hand Surg Asian Pac,2017,22(4):416.
[10] 蒋曙,尹善青.钩钢板内固定治疗Ⅲ型锤状指[J].中医正骨,2013,25(7):62-63.
[11] Basar H, Basar B, Basc O, et al.Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only[J].Arch Orthop Trauma Surg,2015,135 (4) :499-504.
[12] Imoto FS, Leão TA, Imoto RS, et al.Osteosynthesis of Mallet finger using plate and screws: evaluation of 25 patients[J].Rev Bras Ortop,2016,51(3):268-273.
[13] Bloom JM, Khouri JS, Hammert WC. Current concepts in the evaluation and treatment of Mallet finger injury[J].Plast Reconstr Surg,2013,132(4):560e.
[14] Wehbé MA, Schneider LH. Mallet fractures[J].J Bone Joint Surg(Am),1984,66(5):658.
