CAJ | 학술논문

背景：骨折必须正确复位，不能有成角、旋转、重叠移位，克氏针内固定适用于近、中节指骨初掌骨横断骨折，而微型钢板内固定适用于掌骨及近节指骨干损形或短斜面骨折，那么哪种方式更适合掌骨复杂骨折呢？ 　　目的：对比分析微型钢板与克氏针置入内固定修复掌骨复杂性骨折的临床疗效及安全性。 　　方法：选取佛山市中医院三水医院收治的68例72处掌骨复杂性骨折的患者作为研究对象，均进行切开复位内固定治疗。按随机数字表法分为两组，微型钢板组36例(39处)，克氏针组32例(33处)。对掌指骨骨折愈合时间、功能恢复情况及伤口感染情况进行统计观察，比较两组临床疗效及并发症发生情况，采用X射线观察骨折愈合情况，手部功能恢复情况采用美国手外科协会评分进行评价。 　　结果与结论：微型钢板组随访3-12个月，克氏针组随访3-10个月。微型钢板组的美国手外科协会评分优良率为92%；X射线片显示骨折愈合时间为4-6周，平均4.7周；并发症：未发生骨不连的情况，且闭合性骨折的患者没有发生术后感染，开放性骨折的患者中有3处骨折处发生了不同程度的感染。克氏针组的美国手外科协会评分优良率为76%；X射线片显示骨折愈合时间为6-9周，平均7.7周；并发症：3处骨折处发生了骨不连，植骨后的骨折愈合有28处开放性骨折处有4处发生了术后感染。经统计分析，随访3个月两组患者美国手外科协会评分差异有显著性意义(P<0.05)。提示采用微型钢板置入内固定修复掌骨复杂性骨折的临床效果明显优于克氏针，可作为临床上掌骨复杂性骨折的有效修复方法。
배경：골절필수정학복위，불능유성각、선전、중첩이위，극씨침내고정괄용우근、중절지골초장골횡단골절，이미형강판내고정괄용우장골급근절지골간손형혹단사면골절，나요나충방식경괄합장골복잡골절니？ 　　목적：대비분석미형강판여극씨침치입내고정수복장골복잡성골절적림상료효급안전성。 　　방법：선취불산시중의원삼수의원수치적68례72처장골복잡성골절적환자작위연구대상，균진행절개복위내고정치료。안수궤수자표법분위량조，미형강판조36례(39처)，극씨침조32례(33처)。대장지골골절유합시간、공능회복정황급상구감염정황진행통계관찰，비교량조림상료효급병발증발생정황，채용X사선관찰골절유합정황，수부공능회복정황채용미국수외과협회평분진행평개。 　　결과여결론：미형강판조수방3-12개월，극씨침조수방3-10개월。미형강판조적미국수외과협회평분우량솔위92%；X사선편현시골절유합시간위4-6주，평균4.7주；병발증：미발생골불련적정황，차폐합성골절적환자몰유발생술후감염，개방성골절적환자중유3처골절처발생료불동정도적감염。극씨침조적미국수외과협회평분우량솔위76%；X사선편현시골절유합시간위6-9주，평균7.7주；병발증：3처골절처발생료골불련，식골후적골절유합유28처개방성골절처유4처발생료술후감염。경통계분석，수방3개월량조환자미국수외과협회평분차이유현저성의의(P<0.05)。제시채용미형강판치입내고정수복장골복잡성골절적림상효과명현우우극씨침，가작위림상상장골복잡성골절적유효수복방법。
BACKGROUND:Fracture must be properly reset, cannot present angle, rotation and overlapping shift. Kirschner wire fixation is fit for transverse fracture of first metacarpal bone of proximal phalanx and middle phalanx. Mini-plate fixation is fit for disfigurement or short bevel fracture of metacarpal bone and proximal finger backbone. Which is fit for cmplicated fracture of metacarpal bone? OBJECTIVE:To analyze the clinical effective and safety of complicated metacarpal fractures after fixed with mini-plates and Kirschner wires. METHODS:A total of 68 cases of complicated metacarpal fractures (72 sites) were chosen from Sanshui Hospital of Foshan Municipal Hospital of Traditional Chinese Medicine as the research subjects. They received open reduction and internal fixation, and were divided into two groups. Mini-plate group contained 36 cases (39 sites). Kirschner wire group contained 32 cases (33 sites). Healing time of metacarpal and phalangeal fractures, functional recovery and wound infection were observed. Clinical effects and complications were compared between the two groups. Bone healing was observed using X-ray. The recovery of hand function was evaluated using total action flexion score of American Society for Surgery of the Hand. RESULTS AND CONCLUSION:Patients in the mini-plate group were fol owed up for 3-12 months, and patients in the Kirschner wire group were fol owed up for 3-10 months. In the mini-plate group, the excel ent and good rate of total action flexion score was 92%. X-ray films revealed that healing time was 4-6 weeks, averagely 4.7 weeks. Complications:no bone nonunion occurred. Moreover, patients with closed fracture did not suffer from postoperative infection. Patients with open fracture suffered from infection to different degrees at three fracture sites. In the Kirschner wire group, the excel ent and good rate of total action flexion score was 76%. X-ray films demonstrated that healing time was 6-9 weeks, averagely 7.7 weeks. Complications:bone nonunion was observed at three fracture sites. After bone grafting, postoperative infection was found in 4 sites of 28 sites of open fracture. Statistical analysis showed that significant differences in total action flexion score were detectable between the two groups at 3 months of fol ow-up (P<0.05). These results suggest that the clinical effect of mini-plate fixation for complicated metacarpal fracture was apparently better than that of Kirschner wire, so mini-plate fixation can be used as an effective repair method for complicated metacarpal fracture.