钢板与克氏针固定Bennett骨折的比较△

Comparison of plate versus Kirschner wire for internal fixation of Bennett fracture

摘要:

［目的］比较切开复位钢板固定与闭合复位经皮克氏针固定治疗 Bennett 骨折的临床效果。［方法］回顾性分析本院 2015 年 1 月—2019 年 1 月手术治疗 Bennett 骨折 52 例患者的临床资料。依据术前医患沟通结果，28 例采用切开复位钢板固定，24 例采用闭合复位经皮克氏针固定。比较两组围手术期、随访与影像资料。［结果］两组患者均顺利完成手术。钢板组术中透视次数、恢复主动活动时间显著优于克氏针组 （P<0.05），但前者术中失血量显著多于后者 （P<0.05）。平均随访时间 （18.4±3.6） 个月，两组恢复完全负重时间的差异无统计学意义 （P>0.05）。随着术后时间推移，两组 DASH 评分均显著下降 （P<0.05），术后 3 个月钢板组 DASH 评分显著优于克氏针组（P<0.05），但术后 1 年两组间的差异无统计学意义（P>0.05）。影像方面，两组骨折对合和第一掌腕对线较术前显著改善 （P<0.05），术前两组骨折对合及第一掌腕对线的差异均无统计学意义 （P>0.05），但是末次随访时钢板组上述影像指标均显著优于克氏针组 （P<0.05）。两组骨折愈合时间差异无统计意义 （P> 0.05）。［结论］两种术式治疗 Bennett 骨折均可获得良好疗效，各具优缺点，切开复位钢板固定复位精准，固定牢靠。

Abstract:

[Objective] To compare the clinical outcomes of open reduction and internal fixation (ORIF) with locking plate fixation ver- sus closed reduction and percutaneous Kirschner wire fixation of Bennett fracture. [Methods] A retrospective study was performed on 52 patients who received surgical treatment for Bennett fracture in our hospital from January 2015 to January 2019. According to preoperative doctor-patient communication, 28 patients had plate used, while the remaining 24 patients had Kirschner wire applied. The data regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had cor- responding procedures conducted successfully. The plate group proved significantly superior to the wire group in terms of times of fluorosco- py and the time to return active activity (P＜0.05) , whereas the former got significantly more intraoperative blood loss than the latter (P＜ 0.05) . All the patients were followed up for (18.4±3.6) months on an average, with no a significant difference in the time to resume fullweight bearing activity between the two groups (P＞0.05) . The DASH scores decreased significantly in both groups over time after operation (P＜0.05) , which were not significantly different between the two groups at 1 year after operation (P＞0.05) . Radiographically, fracture align- ment and first metacarpal alignment in both groups significantly improved postoperatively compared with those preoperatively (P＜0.05) , which proved not significant between the two groups before operation (P＞0.05) , whereas the plate group were significantly better than the wire group at the latest follow-up (P＜0.05) . However, there was no significant difference in fracture healing time between the two groups (P＞0.05) . [Conclusion] Both plate and wire for fixation are effective treatment of Bennett fracture, with their own advantages and disadvan- tages. By comparison, the ORIF with plate is more accurate and reliable than the percutaneous Kirschner wire.