Department of Hand Surgery, Tokyo Hand Surgery & Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan.
Department of Hand Surgery, Tokyo Hand Surgery & Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan.
J Hand Surg Am. 2024 Mar;49(3):279.e1-279.e7. doi: 10.1016/j.jhsa.2022.06.028. Epub 2022 Aug 13.
This study aimed to estimate the risk factors for distal phalangeal nonunion in cases involving Kirchner wire fixation after successful fingertip replantation.
This study retrospectively analyzed 116 digits of 111 patients, including 74 and 42 digits with replantation in Tamai zones I and II, respectively. Univariate and multivariable analyses were performed to assess the influences of 15 independent variables on nonunion, including age, sex, medical history of diabetes mellitus, history of smoking, injured hand and digit, injury type (clean, blunt, and crush-avulsion), amputation type (complete or incomplete), length of the distal bone fragment (mm), fracture type (simple or comminuted), presence of a bone defect, length of the fracture gap after fixation (mm), number of Kirchner wires used, evidence of venous repair, and the occurrence of pin tract infections after fixation.
At 12 months after replantation, 100 digits showed bony union and 16 (13.8%) digits showed radiographic nonunion or equivalent complications, including 9 digits with asymptomatic nonunion without a secondary operation, 5 that underwent an additional operation for nonunion or a complication, and 2 with distal bone resorption. A multivariable analysis indicated that the postfixation fracture gap was the only significant predictor influencing nonunion (odds ratio, 3.30; 95% confidence interval, 1.92-5.68).
The extent of the postfixation fracture gap had the greatest influence on preventing distal phalangeal nonunion, indicating the importance of reducing the fracture gap in primary fixation as much as possible.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
本研究旨在评估克氏针固定治疗指尖再植术后远节指骨骨不连的危险因素。
本研究回顾性分析了 111 例患者的 116 个手指，其中 Tamai Ⅰ区和Ⅱ区再植分别为 74 个和 42 个手指。采用单因素和多因素分析评估 15 个独立变量对骨不连的影响，包括年龄、性别、糖尿病病史、吸烟史、受伤手和手指、损伤类型（清洁、钝器、挤压-撕脱）、截肢类型（完全或不完全）、远节骨碎片长度（mm）、骨折类型（简单或粉碎性）、是否存在骨缺损、固定后骨折间隙长度（mm）、使用的克氏针数量、静脉修复证据以及固定后针道感染的发生。
再植后 12 个月，100 个手指显示骨性愈合，16 个（13.8%）手指显示影像学骨不连或等效并发症，其中 9 个手指无症状性骨不连无需二次手术，5 个手指因骨不连或并发症行额外手术，2 个手指出现远节骨吸收。多因素分析表明，固定后骨折间隙是影响骨不连的唯一显著预测因素（比值比，3.30；95%置信区间，1.92-5.68）。
固定后骨折间隙的大小对预防远节指骨骨不连的影响最大，这表明在初次固定时尽可能减少骨折间隙的重要性。
研究类型/证据水平：预后 IV 级。
