腓骨骨折术后并发趾屈曲畸形的治疗

Treatment of flexion deformity of the hallux after fibular fracture

目的探讨腓骨骨折切开复位内固定术后并发!趾屈曲畸形的病因、临床表现、解剖学特征、诊断及治疗方法。方法1996年10月至2004年3月,腓骨骨折术后并发!趾屈曲畸形患者33例,男19例,女14例;年龄22～49岁,平均33.2岁。其中合并踝关节骨折24例,根据Lauge-Hansen分型:旋前-外旋型18例,旋后-外旋型4例,旋前-外翻型2例;胫腓骨远端1/3螺旋形骨折9例。腓骨骨折均行切开复位钢板螺钉内固定术。患者均于术后1～5个月,平均3个月出现!趾屈曲畸形。其中单纯!趾屈曲畸形19例,伴二、三趾屈曲畸形8例,伴二至五趾屈曲畸形6例。采用单纯肌腱粘连松解术、单纯!长屈肌腱延长或合并趾长屈肌腱延长术矫正畸形。结果19例单纯!趾屈曲畸形患者,7例行单纯!长屈肌腱粘连松解术,12例行!长屈肌腱延长术。14例合并其余足趾屈曲畸形患者,6例行单纯!长屈肌腱延长术,8例行!长屈肌腱合并趾长屈肌腱延长术。术后随访2～10个月,平均6个月,所有患者足趾畸形完全矫正,疼痛缓解,步态及穿鞋改善,无畸形复发。结论腓骨骨折术后并发!趾屈曲畸形,!长屈肌腱与骨折处粘连是重要因素。在Henry结部位,!长屈肌腱与趾长屈肌腱之间存在腱性连接的解剖变异,对于足部矫形手术具有特殊的临床意义。

Objective To discuss the etiology, clinical findings, anatomical characters, diagnosis and treatment of the painful flexion deformity of the hallux after open reduction and internal fixation of the fibular fractures. Methods From October 1996 to March 2004, we treated 33 cases with flexion deformity of the hallux after fibular fracture, including 19 males, 14 females, with a mean age of 33.2 years old （ranged from 22 to 49 years）. 24 cases were ankle fractures, according to Lauge-Hansen clssification, pronation-external rotation for 18 cases; supination-exteral rotation for 4 cases; pronation-eversion for 2 cases. 9 cases were distal third tibial and fibular fractures. 19 cases were simple hallux flexion deformity, 8 cases were combined with the second and third toes deformity, 6 cases were combined with not only the second and third toes but also the fourth and fifth toes deformity. The deformities were corrected by flexor hallucis longns tendolysis or lengthening alone or flexor digitorum longus lengthening in combination. Results 19 cases were simple hallux flexion deformity, the deformities were corrected simply by flexor hallucis longns tendolysis （7 cases） and lengthening （12 cases）. 14 cases were combined with the lesser toes deformity, the flexor hallucis longns tendon were lengthened alone in 6 cases, and both the flexor hallucis longns and the flexor digitorum longns were lengthened in 8 cases. During an average duration of follow-up of 6 months （2 to 10 months）, there were no postoperative complications. All patients had full correction of all deformed toes and reported relief from pain, ease of shoe-fitting and subjective improvement of gait. There was no recurrence of the deformity. Conclusion Adhesions of the flexor hallucis longus tendon to the fibular fracture site should be considered when a flexion deformity of the hallux occurs after open reduction and internal fixation of the fibular fractures. Variations in the interconnections between flexor hallucis longus and flexor digitornm longus in the region of the knot of Henry also have special clinical significance.