减压治疗跗跖关节骨折脱位合并前足筋膜间隙综合征:术后足弓形态及感觉运动功能恢复的评估

Decompression therapy for fore-foot compartment syndromes after fractures and fracture-dislocations of the tarsometatarsal joint: Evaluation on the rehabilitation of shape and feeling of food arch and the motor function

目的:评估减压治疗跗跖关节骨折脱位合并前足筋膜间隙综合征的疗效和前足感觉及运动功能的康复。方法:于1996-05/2003-04选择第二军医大学长征医院骨科收治的跗跖关节骨折脱位合并前足筋膜间隙综合征患者17例,利用whiteside测压装置进行前足部筋膜间隙内压监测,间隙内压>3.99kPa,均经前足背侧入路进行筋膜间隙切开减压术,同时行复位内固定恢复足的纵弓及横弓。固定48h后,进行功能康复训练,主、被动地活动前足各关节及短波红外线治疗。结果:术后1个月进行第一次随访,前两年每3个月随访1次,以后每半年随访1次。17例患者均随访3.5以上。术后6个月随访时评估疗效,足外形正常,活动范围正常,负重行走无不适,X射线片显示正常11例;足活动轻度受限,不影响行走、工作,可进行适当的体育活动,X射线片显示跗跖关节移位<2mm4例;行走或站立过久时前足部有轻度疼痛4例,其中3例前足增宽,足弓较健侧减小,2例两点辨别觉、痛觉略减退。无一例出现前足僵硬、爪形趾、软组织萎缩及运动功能异常。结论:减压是治疗跗跖关节骨折脱位合并前足筋膜间隙综合征的有效方案,减压后应及时进行进行功能康复训练,并辅以短波红外线治疗,能有效地恢复前足感觉、运动功能。

AIM： To evaluate the therapeutic reflect of decompression on fore-foot compartment syndromes after fractures and fracture-dislocations of the tarsometatarsal joint as well as the rehabilitation of fore-foot feeling and motor function： METHODS： Seventeen patients with fracture-dislocation of tarsometatareal joint accompanied by fore-foot compartment syndromes were selected from the Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University of Chinese PLA between May 1996 and April 2003. The compartment pressure of fore-foot was measured with the whiteside equipment with the interstitial pressure 〉 3.99 kPa, and all patients were treated by decompression of fasciotomy through a dorsal fore-foot incision, and reposition and internal fixation were performed at the same time to reconstruct the arches of foot. The rehabilitation treatment was performed in at 48 hours after the fixation, so as to initiatively and passively exercise all joints in the fore-foot as well as conduct the short-wave infrared therapy. RESULTS： First follow-up was conducted at one month after the operation, which was conducted once every three months in the first two years, and once every 6 months after the second years. All of the 17 patients were followed up at a mean period of 3.5 years. The evaluation was conducted in the follow-up at 6 months after the operation. The feet of 11 patients were normal in shape with normal motion range, and there was no complaint in loading walk, and they were normal in the X ray inspection. Four patients were slightly limited in motion without influences on walking and working, while proper sports activities could be done, and the X-ray showed a displace of tarsometatarsal joint less than 2 mm. Another 4 patients had occasional fore-feet pain after walking or standing for a long time, and the fore-feet width was increased and the arch of feet was decreased in 3 patients, and two of them suffered from deceased pin-stick sensation and two-point discrimination. None of the cases got stiffness of the fore-foot associated with claw toes, soft-tissue contracture and motor deficit. CONCLUSION： It is effective to treat the compartment syndromes of the fore-foot after fractures and fracture-dislocations of the tarsometatarsal joint by decompression. The post-operational rehabilitation training aswell as soft-wave infrared therapy should be conducted in time, which are helpful to the reconstruction of fore-foot feeling as well as motor function.