掌指骨骨折的手术治疗

目的：探讨合理、有效的掌指骨骨折的治疗方法，以期提高治疗效果。方法：本组295例，男228例，女67例；年龄14～65岁，平均29岁。采用钢丝固定（45例，A组）、微型接骨钢板固定（65例，B组）、单根克氏针内固定（97例，C组）及双根克氏针内固定（88例，D组）4种方法治疗，并对不同的治疗方法及效果进行评定。结果：术后平均随访18个月（6～72个月），按掌指关节伸屈正常范围标准进行评定，优100例，良165例，可17例，差13例。A组：优12例，良24例，可4例，差5例，优良率80．0％；B组：优20例，良37例，可5例，差3例，优良率87．6％；C组：优38例，良55例，可2例，差2例，优良率95．8％；D组：优30例，良49例，可6例，差3例，优良率89．7％。结论：钢丝法不应作为常规治疗和首选，仅适合于掌指骨横形骨折；微型钢板对多发性、移位骨折可取得良好效果；对于大多数手部骨折，克氏针固定是有效、可靠的手术方式。

Comparison of four internal fixation methods for the treatment of metacarpophalangeal fractures

Objective: To explore reasonable and effective methods for the treatment of metacarpophalangeal fractures,so as to improve its therapeutic effects.Methods:Two hundred and ninety-five patients (male 228 and female 67,ages from 14 to 65,with an average of 29) were treated with four different methods:45,65,97 and 88 patients were fixed with steel wire (Group A),mini steel plate (Group B),one Kirschner pin (Group C) and two Kirschner pins (Group D) respectively.The clinical results of the four groups were analyzed.All the patients were followed up for an average of 18 months (6 to 72 months) and evaluated according to extension and flexion functions of metacarpophalangeal joints.Results:Of 295 patients,100 exhibited excellent curative effect,165 showed good result,17 were fair and 13 were poor.In Group A,excellent effects occurred in 12 patients,good in 24,fair in 4 and poor in 5,with total excellent and good rate of 80.0%;the numbers of cases with excellent,good,fair and poor curative effect and the rate of total excellent and good curative effect were 20,37,5,3 and 87.6% respectively in Group B;correspondingly,they were 38,55,2,2 and 95.8% in Group C;and 30,49,6,3 and 89.7% in Group C respectively.Conclusion:Steel wire fixation should not be selected firstly as a regular method for the treatment of metacarpophalangeal fractures,but can be used to treat transverse fractures of metacarpal bone and phalanx.Mini steel plate can achieve good results to treat multiple and unstable fractures,while Kirschner pins fixation is effective and reliable method for the treatment of most fractures of hands.