CAJ | 학술논문

目的比较闭合复位与开放复位治疗陈旧性骨性锤状指的疗效差异,初步探讨陈旧性骨性锤状指较为合适的治疗手段.方法自2006年1月至2012年2月期间共有81例陈旧性骨性锤状指患者接受手术治疗,手术时间为受伤后8～21周,分别采用闭合性复位克氏针固定术(A组43例),单纯骨折切开复位克氏针固定术(先经闭合性复位克氏针固定但效果不佳,B组21例),微型骨锚重建伸肌腱止点术(先经闭合性复位克氏针固定但效果不佳,C组17例).结果术后随访时间为6～24个月,平均11.1个月.A组:优21例,良16例,可4例,差2例;优良率为86.0％.B组:优9例,良9例,可2例,差1例;优良率为85.7％.C组:优6例,良8例,可1例,差2例,优良率82.4％.损伤8～ 14周患者中,91.9％经闭合复位克氏针固定治疗后骨折愈合;损伤14周以上患者中,79.5％需再次接受切开复位克氏针内固定或微型骨锚重建伸肌腱止点术.结论根据受伤时间的差异,合理应用不同手术方法治疗伸肌腱止点撕脱性骨折锤状指,以期取得较好的疗效.
목적 비교폐합복위여개방복위치료진구성골성추상지적료효차이,초보탐토진구성골성추상지교위합괄적치료수단.방법 자2006년1월지2012년2월기간공유81례진구성골성추상지환자접수수술치료,수술시간위수상후8～21주,분별채용폐합성복위극씨침고정술(A조43례),단순골절절개복위극씨침고정술(선경폐합성복위극씨침고정단효과불가,B조21례),미형골묘중건신기건지점술(선경폐합성복위극씨침고정단효과불가,C조17례).결과 술후수방시간위6～24개월,평균11.1개월.A조:우21례,량16례,가4례,차2례;우량솔위86.0％.B조:우9례,량9례,가2례,차1례;우량솔위85.7％.C조:우6례,량8례,가1례,차2례,우량솔82.4％.손상8～ 14주환자중,91.9％경폐합복위극씨침고정치료후골절유합;손상14주이상환자중,79.5％수재차접수절개복위극씨침내고정혹미형골묘중건신기건지점술.결론 근거수상시간적차이,합리응용불동수술방법치료신기건지점시탈성골절추상지,이기취득교호적료효.
Objective To evaluate the efficacy of closed reduction and open reduction in the treatment of chronic mallet fracture.Methods From January 2006 to February 2012,81 patients with chronic mallet fracture were surgically treated.The interval between injury and operating time of these patients ranged from 8 to 21 weeks.Closed reduction and Kirschner wire fixation was carried out in 43 patients (group A).For cases when attempts of closed reduction and K-wire fixation did not achieve satisfactory results,simple open reduction and K-wire fixation was done in 21 patients (group B) while open reduction and extensor tendon insertion reconstruction with bone anchor was done in 17 patients (group C).Results Postoperatively the patients were follow-up for 6 to 24 months,with an average of 11.1 months.In group A results were excellent in 21 cases,good in 16 cases,fair in 4 cases and poor in 2 cases,with an overall 86.0％ satisfactory rate.In group B results were excellent in 9 cases,good in 9 cases,fair in 2 cases and poor in 1 case,with an overall 85.7 ％ satisfactory rate.In group C results were excellent in 6 cases,good in 8 cases,fair in 1 case and poor in 2 cases,with an overall 82.4％ satisfactory rate.Fractures healed after closed reduction and K-wire fixation in 91.9％ of the patients whose injuries were 8 to 14 weeks old.In patients whose injuries were more than 14 weeks old,79.5％ needed to have open reduction and K-wire fixation or extensor tendon insertion reconstruction with a mini bone anchor.Conclusion Proper application of different surgical procedures based on the differences in injury time can result in good treatment outcomes in treating mallet finger caused by bony avulsion fracture at the extensor tendon insertion.