【摘要】 目的 探讨手指中节指骨基底关节内骨折分型及对应的治疗方法。方法 1998年3月-2014年3月,对90例手指中节指骨基底关节内骨折患者的资料进行分析,根据手指侧位X线片分为以下3型:Ⅰ型:中节指骨基底掌侧或背侧简单骨折;Ⅱ型:中节指骨基底掌侧或背侧粉碎性骨折;Ⅲ型:Pilon骨折(中节指骨基底掌背侧均为粉碎性骨折,关节面塌陷)。Ⅰ型和Ⅱ型根据骨折部位又分为A型:掌侧骨折,B型:背侧骨折。其中ⅠA型32例,ⅠB型13例,ⅡA型22例,ⅡB型8例,Ⅲ型15例。手术方法:(1)闭合复位伸展限制夹板外固定;(2)闭合复位克氏针内固定;(3)开放复位内固定;(4)有限内固定+微型外固定架;(5)动力性牵引外固定装置;(6)掌板推进关节成形术。结果 术后随访12~120个月,平均65个月。所有患者均达到完全骨性愈合及关节复位,愈合时间平均为4个月。应用密歇根州手功能调查表(Michigan Hand Outcome Questionnaire,MHQ)对治疗结果进行主观评价,MHQ评分平均为80(70~92)分。客观评价:握力占健侧90%。近侧指间关节伸直达0°~45°,平均10°;屈曲达45°~110°,平均80.5°。术后轻度针道感染8例,经局部清洁换药治愈,创伤性关节炎4例,其中3例Ⅱ期行关节融合术。结论 手指中节指骨基底关节内骨折的分型有利于手术方法的选择及对预后的判断。对于手指中节指骨基底关节内骨折的治疗要个体化,应根据骨折类型及骨关节损伤程度选择合适的治疗方法,才能提高疗效,减少并发症。更多还原

【Abstract】 Objective To discuss the classification and treatment of intra-articular fractures of the base of the middle phalanx.Methods 90 cases of intra-articular fractures in the base of the middle phalanx treated from March 1998 to March 2014 were reviewed.The cases were divided into three types according to the lateral x-ray films of the fingers.Type Ⅰ(45 cases):single palmar or dorsal fracture fragment;type Ⅱ(30cases):comminuted palmar or dorsal fracture fragment;type 111(15 cases):Pilon fracture.Typel and type Ⅱwere further divided into subtypeA:palmar fracture and subtype,B:dorsal fracture.Treatment techniques including:(1) Closed reduction and extension block splinting;(2) Closed reduction and internal fixation with several pins;(3) Open reduction and internal fixation;(4) Limited internal fixation combined with mini external fixator;(5) Elastic dynamic external fixator;(6) Volar plate arthroplasty.Results The followups lasted from 12 to 120 months,with a mean period of 65 months.All of the cases healed and obtained reduction of proximal interphalangeal joint completely.The average healing period was 4 months.We used the Michigan Hand Outcome Questionnaire(MHQ) to obtain a subjective response to the treatment.The mean normalised Michigan hand outcome score for the injured hand was 80(70 to 92).Objective evaluation:Grip strength scored 90%compared with the contralateral hand,Extension angle of proximal interphalangeal joint was from 0° to 45°,averaging 10°.Flexion angle was from 45° to 110°,averaging 80.5°.The complications included that superficial infection of pin site only noted in 8 cases which healed by local clean care and 4 cases suffered from severe traumatic arthritis in which 3 were cases treated with fusion of the impaired joints.Conclusion Classification of intra-articular fractures of the base of the middle phalanx is useful for the selection of proper operation procedures and the assessment of prognosis.The treatment protocol of intra-articular fractures of the base of the middle phalanx should be Individualized and it should be determined based on the type of fracture and severity of bone and joint injury to improve the effect and reduce the complications.更多还原