Szalay G, Schleicher I, Kraus R, Pavlidis T, Schnettler R
Universität Giessen, Klinik und Poliklinik für Unfallchirurgie, Rudolf-Buchheim-Straße 7, Giessen.
Handchir Mikrochir Plast Chir. 2011 Feb;43(1):46-53. doi: 10.1055/s-0030-1267992. Epub 2010 Dec 15.
The aim of the present investigation was to evaluate the outcome after operative treatment of dorsal distal phalanx fractures near to the base of type Doyle IVb and IVc by means of a hook plate.
Between February 2002 and September 2009 77 patients were treated by operation by means of 77 hook plates because of a fracture of the dorsal distal phalanx near to the base of type Doyle IVb and IVc. 59 of these patients, 13 women, 46 men, with an average age of 29.3 (13-72) years were followed up for on average 38.3 (3-69) months after operation. At follow-up the range of movement in the distal interphalangeal joint was measured compared to the other hand, nail growth defects were registered and an X-ray examination of the finger was performed. The patients were asked about pain, limitations of function, the satisfaction with the aesthetic result and whether the patients would undergo the same operation once more. The total result was judged by means of a self-made scale of assessment by evaluating the objective and subjective data.
Postoperative bleeding, disorders of wound healing and infections were not observed. In 7 patients nail growth defects were found, 3 of which were subjectively very irritating. The material for osteosynthesis was removed 14 times, while the plate had to be removed prematurely due to imminent perforations two times. After a renewed trauma, a dislocation of the fragments was observed. The mean range of movement in the distal interphalangeal joint was amounted to 77 (0-90) degrees, showing a mean deficiency in extension of 7 degrees (0-32 degrees) and a mean deficiency in flexion of 7 degrees (0-40 degrees) compared to the unharmed opposite side. The total result was assessed 51 times (84.7%) as very good, 5 times (8.5%) as good and 4 times (6.8%) as bad.
Even if the operation technique is relatively uncomplicated and even in the majority of the cases one can achieve very good or good results in the treatment of the dorsal distal phalanx fractures near to the base, the rate of complication is significant with 7 nail growth defects and two premature removals of the plate due to imminent perforation of the skin. Considering this rate of complication the indication, the operation technique and the implant require verification.
本研究旨在评估采用钩钢板手术治疗多伊尔IVb型和IVc型靠近指骨基底的远节指骨背侧骨折后的疗效。
2002年2月至2009年9月期间，77例因多伊尔IVb型和IVc型靠近指骨基底的远节指骨背侧骨折患者接受了77次钩钢板手术治疗。其中59例患者，13例女性，46例男性，平均年龄29.3岁（13 - 72岁），术后平均随访38.3个月（3 - 69个月）。随访时，测量患指远侧指间关节的活动范围并与对侧进行比较，记录指甲生长缺陷情况，并对患指进行X线检查。询问患者疼痛情况、功能受限情况、对美观效果的满意度以及是否愿意再次接受相同手术。通过对客观和主观数据进行评估，采用自制评估量表判断总体疗效。
未观察到术后出血、伤口愈合障碍及感染情况。7例患者出现指甲生长缺陷，其中3例患者主观上感觉非常困扰。内固定材料取出14次，因皮肤即将穿孔导致钢板提前取出2次。再次受伤后，观察到骨折块移位。远侧指间关节的平均活动范围为77°（0 - 90°），与未受伤的对侧相比，平均伸直受限7°（0 - 32°），平均屈曲受限7°（0 - 40°）。总体疗效评估为非常好的有51次（84.7%），好的有5次（8.5%），差的有4次（6.8%）。
即使手术技术相对简单，且在大多数病例中，治疗靠近指骨基底的远节指骨背侧骨折能取得非常好或较好的效果，但并发症发生率仍较高，有7例指甲生长缺陷，2例因皮肤即将穿孔而提前取出钢板。考虑到这一并发症发生率，手术指征、手术技术及植入物均需进一步验证。
