SPin微型螺钉治疗手指关节内骨折

目的 探讨应用Spin螺钉治疗手指关节内骨折的方法及其临床疗效.方法 2004年10月至2007年10月,应用Spin螺钉治疗手指关节内骨折22例,男15例,女7例;年龄18～65岁,平均31岁.涉及掌指关节内骨折9例,近侧指间关节内骨折11例,远侧指间关节内骨折2例.开放性骨折9例,闭合性骨折13例.开放性损伤中合并肌腱损伤7例,1例合并拇指末节离断.采用1枚Spin螺钉内固定14例,采用2枚Spin螺钉内固定5例,采用1枚Spin螺钉并克氏针内固定3例.术后2周开始进行早期功能锻炼.结果 术后伤口均一期愈合,经6～12个月(平均8个月)的随访,无伤口感染及骨髓炎发生.所有病例骨折均愈合,临床愈合时间为3～6周,骨性愈合时间为7～12周,内固定拆除时间为8～26周,无创伤性关节炎发生.手指关节活动度按TAM法进行评价,优15例、良5例、中1例、差1例,优良率90.9%.其中掌指关节内骨折9例.8例活动度0°～90°,1例活动度O°～75°;近侧指间关节内骨折11例,8例活动度0°～11°.,2例活动度O°～90°,1例活动度0°～50°;远侧指间关节内骨折2例,活动度0°～50°.结论 对于手指关节内骨折,行切开复位,Spin螺钉内固定,具有固定可靠、复位满意等优点,是一种有效的手术方法.选择合适的适应证,熟练的手术技巧及早期功能锻炼可以获得满意的疗效.

The Spin screw fixation of finger intra-articular fractures

Objective The purpose is to evaluate the clinical effectiveness and functional outcone of with open reduction and internal fixation with Spin screw in the treatment of intra-articular fractures of fingers. Methods Twenty-two patients with finger intra-articular fractures were treated with operative fixation with Spin screw from October 2004 to October 2007. There were fifteen males and seven females. The patients ranged from eighteen to sixty-five years old, with an average age of 31 years. There were metacar-pophalangeal joint fracture in 9 cases, proximal interphalangeal joint fracture in 11 cases, distal interpha-langeal joint fracture in 2 cases. There were open fracture in 9 cases and closed fracture in 13 cases o One spin screw were needed to achieve stability in 14 cases, two Spin screw in 5 cases, a Spin screws and Kirschner wire in 3 cases. The patients were required to begin their early functional exercise two weeks after the operation. Results All wound healed evenly. No infection or osteomyelitis were found. All the patients were followed up for 6 to 12 months, with an average of eight months. All fractures healed. The clinical u-nion time varied 3 to 6 weeks; the bone union time varied 7 to 12 weeks. The time of implant removal was arranged at time of 8 to 26 weeks postoperatively. No traumatic arthritis was observed in the group during follow-up . Finger joint motion was assessed according to TAM Evaluation. 15 cases had excellent result; 5 cases good; 1 moderate and 1 with poor. The ratio of excellent or good results was 90.9 %. In metacar-pophalangeal joint fracture, the range of motion in metacarpophalangeal joints was 0°-90° in 8 cases; the one was 0°-75°in remaining one.In proximal interphalangeal joint fracture, the range of motion in proximal interphalangeal joint was 0°-110 ° in 8 cases, 0°-90°in 2 cases; 0°-50°in 1 case. The range of motion in distal interphalangeal joint was 0°-50°. Conclusion Spin crew fixation can provid stable fixation for the treatment of finger intra-articular fractures. Desirable clinical outcomes can be achieved by proper use, skilled surgical technique and early functional exercise.