CAJ | 학술논문

目的评价AO微犁钢板内固定治疗指骨骨折的术后功能,并探讨可能影响功能恢复的因素.方法对2003年9月至2008年8月问39例(40指)行微犁钢板内固定并取出且获得随访的指骨骨折患者临床资料进行回顾性分析.并对随访患者进行满意度测评,采用Tang提出的手功能评定标准进行功能评价,并分析年龄、指别、钢板类型、骨折类型等与功能评级的关系.结果术后随访3～63个月(平均25个月).患者满意度评价:23.1%(9/39)的患者满意,23.1%(9/39)的患者基本满意,35.9%(14/39)的患者欠满意,17.9%(7/39)的患者不满意.患指术后功能按Tang手功能标准评定:优+5指,优-1指,良+4指,良-5指,中14指,差7指,失败4指.无骨不愈合、骨不连、钢板断裂等并发症发生.低龄组(≤45岁)的功能评级明显优于高龄组(＞45岁)(P＜0.01).拇指与其他四指功能级别有明显差异,拇指功能恢复要比其他四指差.软组织或关节面损伤、开放或粉碎性骨折以及骨折类型等风险因素对功能评级在统计学上没有影响.结论微型钢板可以为小稳定的、复杂的指骨骨折提供稳定可靠的内固定.低龄患者的功能恢复明显优于高龄患者,拇指功能恢复明显低于其他四指.指骨骨折术后指关节容易发生僵硬.
목적 평개AO미리강판내고정치료지골골절적술후공능,병탐토가능영향공능회복적인소.방법 대2003년9월지2008년8월문39례(40지)행미리강판내고정병취출차획득수방적지골골절환자림상자료진행회고성분석.병대수방환자진행만의도측평,채용Tang제출적수공능평정표준진행공능평개,병분석년령、지별、강판류형、골절류형등여공능평급적관계.결과 술후수방3～63개월(평균25개월).환자만의도평개:23.1%(9/39)적환자만의,23.1%(9/39)적환자기본만의,35.9%(14/39)적환자흠만의,17.9%(7/39)적환자불만의.환지술후공능안Tang수공능표준평정:우+5지,우-1지,량+4지,량-5지,중14지,차7지,실패4지.무골불유합、골불련、강판단렬등병발증발생.저령조(≤45세)적공능평급명현우우고령조(＞45세)(P＜0.01).무지여기타사지공능급별유명현차이,무지공능회복요비기타사지차.연조직혹관절면손상、개방혹분쇄성골절이급골절류형등풍험인소대공능평급재통계학상몰유영향.결론 미형강판가이위소은정적、복잡적지골골절제공은정가고적내고정.저령환자적공능회복명현우우고령환자,무지공능회복명현저우기타사지.지골골절술후지관절용역발생강경.
Objective To evaluate the postoperative functions of phalangeal fractures treated with AO miniature-plates.Methods From September 2003 to August 2008,39 patients with 40 phalangeal fractures were treated by open reduction and internal fixation with AO miniature-plates which were routinely removed.We retrospectively reviewed their outcomes by a new assessment system on active range of motion,grip strength and quality of motion.Results Postoperative follow-ups ranged from 3 to 63 months,with an average of 25 months.One plate was removed ahead of time because it had been exposed.Two cases had to undergo digital amputation because of severe infection and reinjury,respectively.Their postoperative hand functions were graded as excellent in 6 digits (15.0% ),good in 9 digits (22.5% ),fair in 14 digits (35.0%),poor in 7 digits (17.5%),and failed in 4 digits (10.0% ) .There was no nonunion,delayed union,or hardware failure.The functional grading was significantly better in the young group (≤45 yeas old)than in the old group (＞ 45 years old) (P＜0.01).Functional recovery of the thumb was significantly worse than that of other fingers.Fracture type,soft tissue injury,and intra-articular injury had no statistically significant influence on the functional grading.Conclusions The AO mini-plate can provide rigid and firm fixation for unstable and complicated phalangeal fractures.Old patients and the thumb tend to have poorer prognosis.In spite of early postoperative mobilization,joint stiffness still seems a big problem.