Miao Dao-yi, Yang Guo-jing, Zhang Ling-zhou, Wu Jian-wei
Zhongguo Gu Shang. 2015 Oct;28(10):920-3.
To compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint.
From June 2012 to June 2014, totally 41 patients (45 fingers) with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K-wires fixation, and all the patients were followed up. In the dynamic external fixtor combined with limited internal fixation group (group A), there were 21 patients with 22 fingers, including 12 males and 9 females, with an average of (30.6±5.6) years old. In the cross K-wires fixation group (group B), there were 20 patients with 23 fingers, including 11 males and 9 females, with an average of (30.1±5.3) years old. Regular re-examination of X-ray was performed to evaluate the active range of joint motion, fracture healing time, infection rate and postoperative joint motion pain.
According to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association, the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences (Z=2.558, P=0.011). The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was (7.9±2.1) weeks, and (8.1±2.3) weeks for group B. There was no significant difference on the mean healing time (t=-0.304, P=0.762). The infection fingers of group A was 5, and 1 for group B. The difference between the results was statistically significant (χ2=3.287, P<0.05). The infection rate of group A was higher than that of group B. The postoperative joint motion pain was evaluated by VAS score, the mean score was 0.18±0.50 in group A, and 0.65±0.88 in group B. The difference between the results was statistically significant (t=-2.207, P<0.05). The postoperative joint motion pain was lower than that of group B.
Dynamic external fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.
比较动力外固定器联合有限内固定与交叉克氏针固定治疗近节指间关节闭合性Pilon骨折的临床疗效及安全性。
选取2012年6月至2014年6月收治的41例（45指）近节指间关节闭合性Pilon骨折患者，采用动力外固定器联合有限内固定或交叉克氏针固定治疗，并对所有患者进行随访。动力外固定器联合有限内固定组（A组）21例患者22指，其中男12例，女9例，平均年龄（30.6±5.6）岁。交叉克氏针固定组（B组）20例患者23指，其中男11例，女9例，平均年龄（30.1±5.3）岁。定期复查X线，评估关节活动度、骨折愈合时间、感染率及术后关节活动疼痛情况。
根据中华医学会手外科学分会上肢功能评定标准，A组优19例，良13例；B组优13例，良10例。两组评估结果差异有统计学意义（Z=2.558，P=0.011），A组优良率明显高于B组。A组平均骨愈合时间为（7.9±2.1）周，B组为（8.1±2.3）周，两组平均愈合时间差异无统计学意义（t=-0.304，P=0.762）。A组感染指5例，B组1例，差异有统计学意义（χ2=3.287，P<0.05），A组感染率高于B组。术后关节活动疼痛采用视觉模拟评分法（VAS）评估，A组平均评分为0.18±0.50，B组为0.65±0.88，差异有统计学意义（t=-2.207，P<0.05），A组术后关节活动疼痛低于B组。
动力外固定器联合有限内固定是治疗近节指间关节Pilon骨折的可靠、有效方法，可使患者术后早期进行功能康复，恢复关节功能。
