自制简易外固定牵引支架结合克氏针固定治疗近中节指骨干粉碎性骨折

目的：探讨应用自制简易外固定牵引支架结合克氏针固定治疗近、中节指骨干粉碎性骨折的方法和疗效。方法2009年6月-2013年8月，对26例（32处）近、中节指骨粉碎性骨折患者采用自制简易外固定牵引支架结合克氏针及可吸收线固定治疗，并定期随访，观察疗效。结果术后所有病例骨折均愈合，无骨髓炎发生，未出现骨折移位或畸形愈合，有9处骨折在愈合过程中形成外骨痂。按照手指总主动活动度（tatol active motion， TAM）的评级标准并参考手指总主动屈曲度（tatol active flexion， TAF）的评分标准，评定患指运动功能，优5例（5处），良16例（17处），可3例（6处），差2例（4处）；病例优良率80．8％（骨折部位优良率68．8％）。结论应用自制简易外固定牵引支架结合有限内固定治疗近、中节指骨粉碎性骨折方法可靠，手术创伤小，能有效固定骨折，早期进行功能锻炼，恢复手指的运动功能。

Using facile fixative bracket combined kirschner wire to treat comminuted fracture of middle and proximal phalanx

Objective To study the method and effect of using self-made facile fixative bracket combined with Kirschner wire in the treatment of comminuted middle and proximal phalanx fractures. Methods From June 2009 to August 2013, we had treated 26 patients with comminuted middle and proximal phalanx fractures （32 fingers） using self-made facile fixative bracket combined with Kirschner wire and absorbable suture, and all these cases were followed-up and observed regularly. Results All these cases achieved bone healing without osteomyelitis, malunion and fracture displacement after operation, external bone callus formation were found in 9 cases during bone healing process. We evaluated all the cases according to the Tatol Active Motion （TAM） rating system and Tatol Active Flexion （TAF） rating system, excellent cases were 5 （5 lesions）, good were 16 （17 lesions）, fair in 3 （6 lesions）, poor in 2 （4 lesions）, overall excellent and good rate were 80.8% （excellent rate of fracture part was 68. 8%）. Conclusion Using self-made facile fixative bracket combined with limited internal fixation can provide an effective immobilization, less invasion and early exercises to restore the function of the fingers for comminuted fracture of proximal and middle phalanx.