The curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers and its influencing factors / 中国医师进修杂志

ABSTRACT

Objective:To explore the curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers, and analyze the related influencing factors of curative effect.Methods:The clinical data of 100 patients with skeletal mallet fingers from January 2018 to December 2020 in Yanzhou Branch of Affiliated Hospital of Jining Medical University were retrospectively analyzed, and the patients were treated with modified double Kirschner wire compression fixation. Before surgery and 8 weeks after surgery, the Fugl-Meyer score, simple test for evaluating hand function (STEF) score and visual analogue score (VAS) were assessed, and the flexion range of knuckles was measured. The curative effect was evaluated by Crawford standard, excellent and good means was good prognosis, medium and poor was poor prognosis. Binary Logistic regression was used to analyze the influencing factors of curative effect in patients with skeletal mallet fingers, Spearman method was used to analyze correlation.Results:All incisions healed in the first stage 14 d after surgery, the function and structure of the hand recovered well, and related incision skin necrosis and needle tract infection did not occur. Compared with before surgery, the Fugl-Meyer score, STEF score and flexion range of knuckles 8 weeks after surgery were significantly higher (62.58 ± 4.56) scores vs. (32.33 ± 2.84) scores, (91.31 ± 3.19) scores vs. (62.51 ± 3.42) scores and (66.72 ± 3.65)° vs. (45.56 ± 2.31)°, the VAS was significantly lower (2.65 ± 1.19) scores vs. (5.68 ± 1.43) scores, and there were statistical differences ( P<0.01). According to Crawford standard, good prognosis was in 79 cases, and poor prognosis was in 21 cases. There were no statistical differences in gender composition, injury location, cause of injury and type of injury between good prognosis patients and poor prognosis patients ( P>0.05); compared with the poor prognosis patients, the good prognosis patients were younger, the time from injury to surgery was shorter, the injured parts were mainly the little finger and ring finger, and there were statistical differences ( P<0.05 or <0.01). Binary Logistic regression analysis result showed that age, time from injury to operation and injury site were independent risk factors of curative effect in patients with skeletal mallet fingers ( OR = 4.62, 5.94 and 2.33; 95% CI 1.06 to 20.14, 2.23 to 15.81 and 1.12 to 4.82; P<0.05 or <0.01). Spearman correlation analysis result showed that the curative effect was positively correlated with age, time from injury to operation and injury location ( r = 0.25, 0.62 and 0.43; P<0.05 or <0.01). Conclusions:Modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers can promote the recovery of finger function after surgery, but age, damaged location and time of visit are independent risk factors of curative effect.