穿针挤压固定治疗骨性锤状指的手术方法及效果评价

目的：探讨骨性锤状指的手术方法，评价穿针挤压固定治疗骨性锤状指的临床效果。方法：对28例骨性锤状指患者采用切开直视下克氏针穿针挤压复位骨折块并固定的方法进行治疗，观察术后患者远侧指间关节（DIP）屈伸情况、骨折愈合和术后并发症发生情况。结果：术后14个月获得随访患者27例。根据Crawford评定标准评估疗效，术前DIP伸直受限10°～25°或存在明显的屈曲障碍者8例（29.6%），DIP 伸直受限>25°或存在持续疼痛者20例（70.4%）；术后DIP可充分主动屈伸活动、静息或活动时均无疼痛者21例（77.8%）,DIP可充分屈曲、伸直受限0°～10°、静息状态下无疼痛者6例（22.2%）。所有患者骨折均愈合，关节面对位满意，无骨髓炎及创口感染、坏死等并发症，锤状指畸形无复发。结论：采用克氏针穿针挤压固定治疗骨性锤状指简便易行,疗效满意。

Surgical method of fixed needle extrusiion in treatment of bony mallet finger and evaluation on curative effect

Objective To explore the surgical method of bony mallet finger and to evaluate the clinical effect of fixed needle extrusion in treatment of bony mallet finger.Methods 28 patients with bony mallet finger were treated with kirschner needle extrusion to reset the fracture fragments and fix the fracture.The flexion or extension of distal interphalangeal joint(DIP),fracture healing and postoperative complications of the patients were observed.Results 27 patients were followed-up for 14 months.Crawford assessment standard was used to assess the efficacy.Before operation,the DIP extension limitation of 10 °-25 ° or obvious flexion obstacles existed in 8 cases(29.6%);the DIP extension limited by greater than 25 ° or the presence of persistent pain existed in 20 patients(70.4%).After operation,the fully active flexion and extension of DIP without pain in resting or action existed in 21 cases(77.8%);the full flexion of DIP,extension limitation from 0 ° to 10 °without pain in resting state existed in 6 cases(22.2%).All fractures in the patients healed,and the joint face apposition was good without osteomyelitis and wound complications such as infection,necrosis and recurrence of mallet finger deformity.Conclusion Kirschner needle extrusion fixation method for the treatment of bony mallet finger is a simple method with satisfatory curative effect.