微型锁定钢板外置治疗近节指骨粉碎性骨折

目的：探讨采用微型锁定钢板外置联合小切口复位治疗近节指骨粉碎性骨折的临床疗效。方法：自2018年1月至2019年12月，采用微型锁定钢板配合小切口切开复位治疗17例近节指骨粉碎性骨折患者，其中男13例，女4例；年龄16~64（37.2±20.1）岁；2例伴有软组织挤压开放伤，Ⅰ期急诊清创后固定治疗。术后6个月随访时根据美国手外科协会手指总主动屈曲量表（total active flexion scale，TAFS）评价疗效，观察骨折愈合，钉道情况，局部软组织愈合及并发症情况。结果：17例患者均获随访，时间6~12（9.3±3.6）个月。2例出现骨折延迟愈合，1例出现局部皮肤坏死，Ⅱ期植皮修复创面，无外置断钉及感染，皮肤软组织愈合良好，均达到骨性愈合，骨折愈合时间12~24（15.7±2.1）周。术后6个月根据TAFS标准评定：优9例，良5例，差3例。结论：微型锁定钢板外置联合小切口复位治疗近节指骨粉碎性骨折，皮肤软组织情况良好，操作简便，有利于早期功能锻炼，指间关节活动度好，恢复期功能评分优良率高。

Micro-locking plate external fixation for the treatment of proximal phalanx comminuted fractures

Objective: To explore clinical efficacy of external placement of micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fractures.Methods: From January 2018 to December 2019, 17 patients with proximal phalanx comminuted fractures were treated with micro-locking plate combined with small incision open reduction, including 13 males and 4 females, aged from 16 to 64 years old with an average of (37.2±20.1) years old. Two patients were accompanied by soft tissue extrusion and opening injuries, which were treated with fixed treatment after the first-stage emergency debridement. Curative effect was evaluated according to total active flexion scale (TAFS) of American Hand Surgery Association at 6 months after operation;and fracture healing, nailing, local soft tissue healing, complications were observed.Results: All patients were followed up from 6 to 12 months with an avaerge of(9.3±3.6) months. Two patients occurred delayed union, 1 occurred local skin necrosis and was treated with the second-stage skin grafting to repair wound surface. No external screw breakage or infection was reported, skin soft tissue healed favorably and reached bony union, the union time from 12 to 24 weeks with an average of (15.7±2.1) weeks. According to TAFS standard, 9 patients got excellent result, 5 good and 3 poor at 6 months after operation.Conclusion: External micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fracture, which has advantages of good condition of skin and soft tissue, simple operation, early functional exercise, good range of motion of interphalanx joint, and function score of recovery period is high.