CAJ | 학술논문

目的介绍一种改良克氏针张力带法治疗掌骨干骨折的方法,并对其功能进行随访.方法 2008年5月至2012年7月,共收治46例59处掌骨干骨折患者,其中近1/3骨折16处,中1/3骨折26处,远1/3骨折17处.按照AO骨折分型:A1型骨折6处,A2型骨折18处,A3型骨折24处,B2型骨折11处.闭合骨折25例,开放骨折21例,其中3例合并皮肤缺损.术中骨折复位后,采用直径1.0 mm克氏针和0.4 mm钢丝构成张力带固定.除3例皮肤缺损者行皮瓣修复,术后10 d开始功能锻炼外,其余患者均在术后2～3d开始功能锻炼.结果术后骨折复位良好,伤口均Ⅰ期愈合.46例均获得6～ 18个月的随访,平均11个月,骨折均愈合,时间为6～11周,平均7.2周.均未发生骨折移位或畸形愈合.术后3～4个月取出克氏针张力带.按照手指关节总活动度(TAM)标准评定:优46指,良11指,可2指;优良率为96.6％.结论采用改良克氏针张力带法治疗A型和B2型掌骨干骨折,具有组织创伤小、手术方法简便、骨折复位良好、固定牢固、早期功能锻炼等优点.术后效果满意.
목적 개소일충개량극씨침장력대법치료장골간골절적방법,병대기공능진행수방.방법 2008년5월지2012년7월,공수치46례59처장골간골절환자,기중근1/3골절16처,중1/3골절26처,원1/3골절17처.안조AO골절분형:A1형골절6처,A2형골절18처,A3형골절24처,B2형골절11처.폐합골절25례,개방골절21례,기중3례합병피부결손.술중골절복위후,채용직경1.0 mm극씨침화0.4 mm강사구성장력대고정.제3례피부결손자행피판수복,술후10 d개시공능단련외,기여환자균재술후2～3d개시공능단련.결과 술후골절복위량호,상구균Ⅰ기유합.46례균획득6～ 18개월적수방,평균11개월,골절균유합,시간위6～11주,평균7.2주.균미발생골절이위혹기형유합.술후3～4개월취출극씨침장력대.안조수지관절총활동도(TAM)표준평정:우46지,량11지,가2지;우량솔위96.6％.결론 채용개량극씨침장력대법치료A형화B2형장골간골절,구유조직창상소、수술방법간편、골절복위량호、고정뢰고、조기공능단련등우점.술후효과만의.
Objective To introduce the modified Kirschner wire and tension band fixation for treatment of metacarpal shaft fractures and evaluate the treatment outcomes.Methods From May 2008 to July 2012,46 cases of 59 metacarpal shaft fractures were treated.There were 16 proximal fractures,26 middle fractures and 17 distal fractures.According to AO fracture classification,there were 6 type A1,18 type A2,24 type A3 and 11 type B2 fractures.25 cases sustained closed fractures,while 21 cases had open fractures with 3 with skin defects.After open reduction,fractures were fixed with 1.0 mm Kirschner wire and 0.4 mm stainless steel tension band.Functional exercise was initiated 2 to 3 days postoperatively in all the patients except the 3 cases with skin defects treated with flap transplantation when exercises began after 10 days.Results Postoperatively fracture reduction was well maintained.Primary wound healing was obtained in all the cases.Follow-up of 46 patients ranged from 6 to 18 months,averaging 11 months.All the fractures were healed with no displacement or malunion.The healing time was 6 to 11 weeks,with an average of 7.2 weeks.The K wire and tension band were removed after 3 to 4 months.The total active movement of the fingers were excellent in 46 fingers,good in 11 fingers,and fair in 2 fingers.The excellent and good rate was 96.6％.Conclusion The modified Kirschner wire and tension band fixation for treatment of type A and type B2 metacarpal shaft fractures has the advantages of minor tissue trauma,simple surgery,good fracture reduction,strong fixation and early functional exercise.It leads to satisfactory results.