克氏针治疗掌指骨骨折后致手指屈曲畸形的分析

目的分析掌、指骨骨折治疗后出现手指屈曲畸形的原因。方法2003年1月--2007年12月，采用克氏针固定治疗掌、指骨骨折128例，其中掌骨骨折25例，近节指骨骨折37例，中节指骨骨折42例，混合性骨折24例；闭合性骨折38例，开放性骨折90例，均采用不贯穿关节的交叉克氏针及斜行克氏针固定骨折，外固定均采用石膏，其中指间关节屈曲位固定53例，伸直位固定75例，石膏固定3～4周，克氏针固定6～15周。结果随访3～12月，出现近侧指间关节屈曲畸形、活动受限19例（15％）。结论克氏针治疗掌、指骨骨折时常因躲避克氏针而采用屈曲手指位外固定，再由于克氏针本身对指背筋膜的损伤导致关节屈曲畸形。

Analysis of flexion deformity caused by the operation of metacarpal and phalangeal fractures

Objective To discuss the reasons of flexion deformity after surgical treatment of metacarpal and phalangeal fractures. Methods From January 2003 to December 2007, 128 patients suffered from metacarpal and phalangeal fractures were involved to the study. All of the fractures were fixed with Kirschner wires. Among them, 25 cases of metacarpal fractures, 37 proximal phalanx fractures, 42 cases of middle phalanx fractures, 24 cases of multiple fractures were involved. All of the fractures, of which 38 cases of closed fractures and 90 cases of open fractures, were fixed with cross or oblique Kirschner wires. All the K wires did not go through the joints. After the operation, plasters were used for 3-4 weeks, 53 of which in flexion position and 75 in extension position. The K wires were taken out at week 6 to 15 post the operation. Results 19 cases of proximal interphalangeal joint flexion deformity were found （15%）. Conclusion Flexion position was usually used in K wire fixation of metacarpal, phalangeal fractures to avoid the skin stimulation of the tail of K wire. The damage of the dorsal fascia might lead to flexion deformity.