微型内固定系统联合超关节外固定装置治疗手部“漂浮掌指关节”损.docVIP

微型内固定系统联合超关节外固定装置治疗手部“漂浮掌指关节”损 　【摘要】目的：探讨“漂浮掌指关节”的治疗方法及效果。方法：20035~20054月，对16例42处手部同一掌指关节掌骨、近节指骨同时骨折作切开复位、理贝尔微型接骨板内固定系统及微型外固定系统治疗。结果：术后随访5～12个月，平均6月，42处骨折全部顺利愈合，掌指关节功能恢复良好。根据TAM评分，42处为优良，优良率为100％。结论：联合应用微型内外固定系统做超关节固定治疗手部“漂浮掌指关节”骨折，早期能达到坚强可靠固定，辅助以早期功能锻炼，手部功能恢复好，达到满意治疗效果。是治疗手部掌指关节部位骨折的一种理想方法。 【关键词】微型内固定; 微型外固定; 漂浮掌指关节; 超关节固定 Treating Floating Metacarpophalangeal Joint Injury with Minitype Internal and External Fixator Combined with OverArticular Fixation KANG Jin, YANG Bogui Department of Otthopaedics,251 Hospital of PLA,Zhangjiakou, 075000, Hebei China 【ABSTRACT】Objective: To investigate the therapy methods and effect for floating metacarpophalangeal joint injury. Methods： We treaed 42 same metacarpal and proximal interphalangeal fractures by open reduction,open debridement reduction,Li beir microplate interna fixator and minitype mixed external fixator in same metacarpophalangeal joint on 16 patients from may 2003 to may 2005. Results：Followingup period was 5 month to 12 month and the average time was 6 month.The result showed that all the 42 fractures healed,function of metacarpophalangeal joint recovered to normal.According to TAF score,42 case was find and the fine rate was 100%.Conclusion：Minitype internal and external fixator combined with Overarticular fixation was an ideal method for treating floating metacarpophalangeal joint fracture,which can get rigid fixation in early stage.Function of hand can reach to better effect, if combined with early functional exercise. 【KEY WORDS】Minitype internal fixation; Minitype external fixation; Floating articular; Overarticular fixation 1975年Blake和Mcbryde［1］首先提出“浮膝”一词定义同侧股骨和胫骨骨折而造成膝关节两侧力臂丧失完整性的高能量损伤，逐渐在国际上达成共识。近年在临床工作中发现，类似损伤在手部骨折中出现亦较多，尤以累及掌指关节居多，且粉碎严重，治疗中难以达到坚强固定，且效果不良。暂且将该类损伤引以“漂浮”概念，以为方便和理解。手部掌、指骨骨折是临床常见创伤，过去对于闭合骨折多采用手法复位和石膏外固定;开放复位多采用克氏针、钢丝内固定。近年来单纯应用微型接骨板及微型外固定系统治疗手部骨折，取得良好疗效，但这些固定方法有时都不足以维持上述骨折充分稳定，尤其累及关节面粉碎严重的骨折。我们尝试联合应用微型内外固定系统治疗该类骨折，对于本组16例42处严重骨折取得了良好治疗效果。 1资料与方法 11一般资料本组16例42处“漂浮掌指关节”骨折病例，男13例，女3例;年