CAJ | 학술논문

目的探讨自制的克氏针-橡皮筋牵引外固定架治疗陈旧性近侧指间关节骨折脱位的疗效.方法回顾性分析2005年3月至2011年8月采用克氏针-橡皮筋牵引外固定架治疗8例陈旧性近侧指间关节骨折脱位患者资料,男6例,女2例;年龄17～58岁,平均23.2岁;中指5例,环指3例;右侧6例,左侧2例.损伤机制:运动伤6例,交通伤1例,扭伤1例;均为闭合性损伤.根据指间关节骨折脱位的Schenck分型:Ⅰ型4例,Ⅱ型3例,Ⅲ型1例.根据密歇根州手功能调查表(Michigan Hand Outcomes Questionnaire,MHQ)进行主观手功能评分,术前平均为56分,关节活动度为0°.术前患侧握力为健侧的60％～80％.外伤至手术时间为45～90 d,平均58 d.结果 8例患者均获得随访,随访时间6～51个月,平均20.5个月.指间关节骨折均完全骨性愈合及复位,愈合时间2～5个月,平均3个月.术后MHQ评分为84～92分,平均88分.术后患侧握力为健侧的85％～100％.近侧指间关节伸直达到-10°～0°,平均-5°;屈曲达到75°～100°,平均89.4°.术后出现关节间隙轻度狭窄2例,关节面不平整(＜1 mm)2例,关节梭形肿胀2例;术后无一例发生钢针断裂、松动及针道感染等并发症.结论应用克氏针-橡皮筋牵引外固定架治疗陈旧性近侧指间关节骨折脱位,具有微创、固定可靠、疗效肯定等优点.
목적 탐토자제적극씨침-상피근견인외고정가치료진구성근측지간관절골절탈위적료효.방법 회고성분석2005년3월지2011년8월채용극씨침-상피근견인외고정가치료8례진구성근측지간관절골절탈위환자자료,남6례,녀2례;년령17～58세,평균23.2세;중지5례,배지3례;우측6례,좌측2례.손상궤제:운동상6례,교통상1례,뉴상1례;균위폐합성손상.근거지간관절골절탈위적Schenck분형:Ⅰ형4례,Ⅱ형3례,Ⅲ형1례.근거밀헐근주수공능조사표(Michigan Hand Outcomes Questionnaire,MHQ)진행주관수공능평분,술전평균위56분,관절활동도위0°.술전환측악력위건측적60％～80％.외상지수술시간위45～90 d,평균58 d.결과 8례환자균획득수방,수방시간6～51개월,평균20.5개월.지간관절골절균완전골성유합급복위,유합시간2～5개월,평균3개월.술후MHQ평분위84～92분,평균88분.술후환측악력위건측적85％～100％.근측지간관절신직체도-10°～0°,평균-5°;굴곡체도75°～100°,평균89.4°.술후출현관절간극경도협착2례,관절면불평정(＜1 mm)2례,관절사형종창2례;술후무일례발생강침단렬、송동급침도감염등병발증.결론 응용극씨침-상피근견인외고정가치료진구성근측지간관절골절탈위,구유미창、고정가고、료효긍정등우점.
Objective To discuss the clinical outcomes of old fracture-dislocation of proximal interphalangeal joint treated with a self-made distraction external fixator which consists of 3 pins and rubbers.Methods From March 2005 to August 2011,8 cases of old fracture-dislocation of proximal interphalangeal joint treated with a pins-rubber distraction external fixator were retrospectively reviewed.There were 6 males and 2 females,aged from 17 to 58 years,averaged 23.2 years.The middle finger was involved in 5 cases and ring finger was involved in 3 cases.The right hand was affected in six patients,and the left hand was affectd in two patients.The mechanism of injury was sports injury in 6 cases,traffic injuries in 1,and sprain in 1.All of the cases were closed injury.The mean time from injury to surgery was 58 d (range,45-90 d).According to Schenck classification of the proximal interphalangeal joint fracture-dislocation,there were 4 cases of type Ⅰ,3 of type Ⅱ,I of type Ⅲ.Based on the Michigan Hand Outcomes Questionnaire (MHQ) for subjective hand function score,the average preoperative score was 56; the range of motion of proximal interphalangeal joint was 0°.Grip strength was 60％-80％ of the contralateral hand.Results The follow-up lasted 6-51 months,with a mean period of 20.5 months.Solid bone healing was eventually achieved in all patients.The average healing period was 3 months (range,2-5 months).The mean normalized MHQ score was 88 (range,84-92).Grip strength was 85％-100％ of the contralateral hand.Extension of proximal interphalangeal joint was -10°-0° (average,-5°).Flexion angle was 75°-100° (average,89.4°).Postoperative complications included slight joint space narrowing (2 cases),joint incongruity (＜ 1 mm) (2 cases) and fusiform arthrocele (2 cases).No infection,pin loosening,and pin breakage was encounted.Conclusion A pins-rubber distraction external fixator is a minimally invasive,reliable and effective treatment for old fracture-dislocation of proximal interphalangeal joint.