包头医学院学报
包頭醫學院學報
포두의학원학보
JOURNAL OF BAOTOU MEDICAL COLLEGE
2014年
4期
56-59
,共4页
肖建军%刘俊%李匡文%邓翔武
肖建軍%劉俊%李劻文%鄧翔武
초건군%류준%리광문%산상무
锤状指%克氏针%急性期%陈旧性
錘狀指%剋氏針%急性期%陳舊性
추상지%극씨침%급성기%진구성
Mallet Finger%Kirschner wire%Acute phase%Aging phase
目的：介绍锤状指分期方法和不同时期的治疗。方法：2008年1月至2012年1月收治48例51指锤状指患者，病程1~7d为急性期，7~21d为修复期，21d以上为陈旧期，对于急性期患者，局麻下用克氏针固定末节指间关节，固定后在关节处扳弯克氏针，使手指末节过伸位，3周以后取出克氏针（伴撕脱骨折6周拔出），然后加强锻炼；修复期不作处理，建议陈旧期手术；陈旧期在局麻下于中节远端切断伸指肌腱，逆行松解瘢痕至末节指间关节，保持肌腱与瘢痕的连续性，末节指间关节克氏针过伸位固定，然后折叠缝合肌腱，3周后拔出固定，再加强锻炼。结果：术后随访3~6个月，7例急性期骨折愈合，2例陈旧期骨折给予摘除。48例中无1例出现感染，创面均一期愈合。21例23指远侧指间关节的范围与对侧未受伤关节相同，患指无疼痛，患者对外形很满意。1例急性期患者，拔出克氏针1周后再发锤状指，1月后按照陈旧期处理，与另外26例27指有少于10。的主动伸展限制，屈曲正常，无疼痛，患者对外形满意。结论：急性期克氏针过伸位固定，陈旧期瘢痕松解、肌腱折叠缝合是治疗锤状指的较好方法。
目的：介紹錘狀指分期方法和不同時期的治療。方法：2008年1月至2012年1月收治48例51指錘狀指患者，病程1~7d為急性期，7~21d為脩複期，21d以上為陳舊期，對于急性期患者，跼痳下用剋氏針固定末節指間關節，固定後在關節處扳彎剋氏針，使手指末節過伸位，3週以後取齣剋氏針（伴撕脫骨摺6週拔齣），然後加彊鍛煉；脩複期不作處理，建議陳舊期手術；陳舊期在跼痳下于中節遠耑切斷伸指肌腱，逆行鬆解瘢痕至末節指間關節，保持肌腱與瘢痕的連續性，末節指間關節剋氏針過伸位固定，然後摺疊縫閤肌腱，3週後拔齣固定，再加彊鍛煉。結果：術後隨訪3~6箇月，7例急性期骨摺愈閤，2例陳舊期骨摺給予摘除。48例中無1例齣現感染，創麵均一期愈閤。21例23指遠側指間關節的範圍與對側未受傷關節相同，患指無疼痛，患者對外形很滿意。1例急性期患者，拔齣剋氏針1週後再髮錘狀指，1月後按照陳舊期處理，與另外26例27指有少于10。的主動伸展限製，屈麯正常，無疼痛，患者對外形滿意。結論：急性期剋氏針過伸位固定，陳舊期瘢痕鬆解、肌腱摺疊縫閤是治療錘狀指的較好方法。
목적：개소추상지분기방법화불동시기적치료。방법：2008년1월지2012년1월수치48례51지추상지환자，병정1~7d위급성기，7~21d위수복기，21d이상위진구기，대우급성기환자，국마하용극씨침고정말절지간관절，고정후재관절처반만극씨침，사수지말절과신위，3주이후취출극씨침（반시탈골절6주발출），연후가강단련；수복기불작처리，건의진구기수술；진구기재국마하우중절원단절단신지기건，역행송해반흔지말절지간관절，보지기건여반흔적련속성，말절지간관절극씨침과신위고정，연후절첩봉합기건，3주후발출고정，재가강단련。결과：술후수방3~6개월，7례급성기골절유합，2례진구기골절급여적제。48례중무1례출현감염，창면균일기유합。21례23지원측지간관절적범위여대측미수상관절상동，환지무동통，환자대외형흔만의。1례급성기환자，발출극씨침1주후재발추상지，1월후안조진구기처리，여령외26례27지유소우10。적주동신전한제，굴곡정상，무동통，환자대외형만의。결론：급성기극씨침과신위고정，진구기반흔송해、기건절첩봉합시치료추상지적교호방법。
ObjectiVe:To introduce the staging methods and the treatment of the mallet finger at different stages. Methods:48 mallet finger patients with 51 mallet fingers hospitalized from Jan. 2008 to Jan. 2012 were giVen different treatment according to the stages of the disease( acute phase 1~7 days;repair phase 7~21 days;aging phase oVer 21 days). For the patients at a-cute phase,paratelum finger's joints were fiXed with a kirschner wire in the local anesthesia. After being fiXed,the kirschner wire was bent at the joints to make paratelum fingers oVer,and was taken out 3 weeks later( with it taken out siX weeks later in an aVulsed fracture),and then more eXercises were encouraged. For those at repair phase,no special treatment was giVen to them. For those at aging phase,it was suggested that an operation should be performed on them. Tendons were cut at the end of the middle segment in the local anesthesia,releasing retrogradely scar to the paratelum finger's joints to maintain continuity between the tendons and the scar. The end finger's joint was fiXed and stretched out oVer with a kirschner wire,and then tendons were su-tured in folding. Three weeks later the wire was pulled out,and then more eXercises were adVised. ResuIts:The results of 3~6 months follow-up were as follows:7 cases of acute phase fracture healed,in 2 cases of aging phase fracture were remoVed. No one was found to present infection in 48 cases,with wounds primarily healed. The distal interphalangeal of 23 fingers in 21 cases had the same range of actiVities as the contralateral unhurt joints,with no pain and a satisfying affect. 1 case of acute phase had the mallet finger again one week after the kirschner wire was pulled out,and was giVen the treatment 1 month afterwards in the way for the aging phase cases. Of 27,26 cases' fingers had the actiVe stretch limitation less than 10.,buckling normally with no pain and a satisfying appearance. ConcIusion:It is a better method for the treatment of mallet fingers to fiX the end finger with a kirschner wire by stretching the joint oVer at acute phase,and to release the scars with tendons sutured in folding at the aging phase.
