在近端指骨基底采用克氏针固定关节外骨折时,束缚伸肌装置会限制近端指间关节(PIP)的屈曲。
Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx.
作者信息
Sela Yaron, Peterson Caitlin, Baratz Mark E
机构信息
Orthopaedic Specialists, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
Hand (N Y). 2016 Dec;11(4):433-437. doi: 10.1177/1558944716628498. Epub 2016 Mar 3.
Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.
经皮克氏针闭合复位是稳定指骨骨折的最微创外科手术选择。本研究探讨了克氏针置入对近端指间(PIP)关节活动的影响。在4只新鲜冷冻尸体手的手指中,通过在屈肌腱中放置缝线环并通过机械秤对屈肌施加张力来测量PIP关节的屈曲度。记录将PIP关节屈曲至90°或最大屈曲所需的负荷。去除负荷后,在掌指关节(MPJ)周围的3个位置插入克氏针:穿过伸肌腱并穿过MPJ、在伸肌腱止点部位附近并穿过MPJ、穿过矢状带并进入近节指骨(P1)基部。重新施加肌腱上的负荷,并记录3种情况下每种情况的PIP关节屈曲角度。插入克氏针前PIP关节屈曲的平均角度为87°,平均施加的负荷为241 g。当克氏针穿过伸肌腱时屈曲角度为53°,当克氏针放置在肌腱附近时屈曲角度为70°,当克氏针通过矢状带在掌侧板和伸肌腱之间的中点进入P1基部时屈曲角度为75°。与穿过伸肌腱或放置在伸肌腱附近的克氏针相比,远离伸肌腱放置的克氏针对PIP关节屈曲造成的即时束缚较小。