骑缝钉与微钢板内固定跖骨颈骨折的比较

Staples versus mini plate for internal fixation of metatarsal neck fractures

[目的]比较骑缝钉与微钢板内固定治疗跖骨颈骨折的临床疗效。[方法]回顾性分析本院骨科2017年1月—2019年3月收治的第2~5跖骨颈骨折36例患者的资料。依据医患沟通结果,将患者分为两组,18例采用骑缝钉固定,18例采用微钢板固定。比较两组患者的围手术期、随访和影像资料。[结果]所有患者均顺利手术,骑缝钉组切口总长度[(2.54±1.87)cm vs (3.98±1.23) cm,P<0.05]和术中失血量[(5.47±2.31) ml vs (8.21±3.18) ml,P<0.05]均显著优于微钢板组(P<0.05)。随访时间12个月以上,两组在恢复下地行走和完全负重活动时间的差异无统计学意义(P>0.05)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而AOFAS中前足评分和跖屈-背伸ROM均显著增加(P<0.05);末次随访时骑缝钉组的跖屈-背伸ROM显著大于微钢板组[(70.26±8.12)°vs (64.25±7.81)°,P<0.05]。影像方面,两组患者的骨折复位质量和骨折愈合时间差异无统计学意义(P>0.05)。[结论]骑缝钉固定治疗第2~5跖骨颈骨折,手术微创,固定可靠,可减少关节粘连等并发症,利于骨折愈合和关节功能恢复。

[Objective] To compare the clinical outcomes of open reduction and internal fixation with staples versus mini plates for metatarsal neck fractures. [Methods] A retrospective study was conducted on 36 patients who received open reduction and internal fixation for the second to fifth metatarsal neck fractures in our hospital from January 2017 to March 2019. According to the results of doctor-patient communication, the patients were divided into two groups. Of them, 18 patients had fractures fixed with staples, while the remaining 18 patients had mini plate for fracture fixation. The patients of two groups were compared regarding to documents of perioperative period, followup and radiographs. [Results] All patients had open reduction and internal fixation performed smoothly. The staple group proved significantly superior to the plate group in term of total incision length [(2.54±1.87) cm vs(3.98±1.23) cm, P<0.05] and intraoperative blood loss [(5.47±2.31) ml vs(8.21±3.18) ml, P<0.05]. All patients were followed up for more than 12 months. There was no statistically significant difference between the two groups in the time to resume walking and full weight-bearing activities(P>0.05). The VAS scores decreased significantly(P<0.05), while the AOFAS forefoot scores and plantar flexion-dorsal extension ROM increased significantly in both groups over time(P<0.05). The staple group had significantly greater the plantar flexion-dorsal extension ROM than the plate group at the latest followup [(70.26±8.12)° vs(64.25±7.81)°, P<0.05]. With respect to radiographic assessment, there were no statistically significant differences in quality of fracture reduction postoperatively and fracture healing time between the two groups(P>0.05). [Conclusion] The staples used as internal fixation of the second to fifth metatarsal neck fractures takes advantages of minimally invasive surgery, reliable fixation, reducing complications such as ankylosis, and is beneficial to fracture healing and joint function recovery.