断指再植中三种不同内固定方式的临床比较

目的比较断指再植中AO微型钢板、交叉克氏针及十字钢丝3种不同内固定方式的临床疗效。方法AO微型钢板组(A组)30例42指,术后随访3~12个月,平均5.3个月。克氏针组(B组)40例48指,术后随访1年以上。十字钢丝组(C组)35例40指,术后随访4~12个月,平均5.5个月。分析骨折愈合时间、再植指存活率,以及再植指掌指关节和指间关节的功能(TAFS评定标准评定)。结果A、B、C3组再植指存活率分别为92.9%,95.8%和92.5%;3组相比差异无统计学意义(x2=0.52,P>0.05)。A、B、C3组再植指关节活动恢复的优良率分别为84.6%,60.9%,和64.9%;3组相比差异有统计学意义(x2=6.21,P<0.05)。3组骨折愈合时间分别平均为4.8周(4~6周),7.8周(6~9周),6.3周(5~8周)。结论断指再植骨架内固定方法中,AO微型钢板组的疗效明显优于克氏针及十字钢丝组。

Comparison of three internal fixation methods in finger replantation

Objective To compare the clinical results of 3 types of internal fixation methods in finger replantation. Methods Three types of internal fixation of the bone in finger replantation were used: AO mini-plates, crossed K-wires and tension bands. 30 cases with 42 amputated fingers were fixed with AO mini-plates. Follow-up for this group was 5.3 months on average (range 3-12 months). 40 cases with 48 amputated fingers were fixed by crossed K-wires and were followed for more than one year. 35 cases with 40 amputated fingers were treated with tension bands and were followed 5.5 months on average (range 4-12 months). Functions of the metacarpophalangeal and interphalangeal joints were evaluated using TAF scales. Results The difference of survival rate among the three groups was not statistically significant ( x 2=0.52, P >0.05). According to TAF scales, excellent and good rate of 84.6% was achieved in cases treated with AO mini-plates, while in cases fixed with K-wires the excellent and good rate was 60.9% and the tension band group 64.9%. The difference among the three groups was statistically significant ( x 2=6.21, P <0.05). The average duration of bone union was 4.8 weeks for the cases fixed with AO mini-plates, 7.8 weeks for those fixed with K-wires, and 6.3 weeks for the tension band group. Conclusion According to comparison of the joint function and duration of bone healing among the three groups, AO mini-plate is the most favorable internal fixation method in finger replantation.