切开复位内固定治疗跖跗关节损伤伴跖骨骨折

Treatment of tarsometatarsal joint injury combined with metatarsal fracture by open reduction and internal fixation

目的:探讨跖跗关节损伤伴跖骨骨折的治疗方法和注意点。方法:2006年1月至2008年6月收治跖跗关节损伤伴跖骨骨折19例,男13例,女6例;年龄21～56岁,平均38.1岁。跖跗关节损伤分型:单纯内侧柱损伤2例,内侧柱伴中间柱损伤5例,外侧柱伴中间柱损伤3例,三柱损伤9例。跖骨骨折:跖骨干骨折8例,颈部骨折7例,跖骨基底部骨折19例。均采用切开复位克氏针或螺钉内固定。结果:所有切口均I期愈合,未见皮肤坏死等情况。骨折平均愈合时间为11.2周。所有患者均得到随访,时间6～17个月,平均12.8个月。采用美国足踝外科协会(AOFAS)中前足评分标准进行临床评估,患者平均AOFAS评分为(84.500±8.553)分,其中优4例,良9例,一般3例,差3例。患者平均术后6.4个月恢复日常生活。3例患者存在轻度骨关节炎表现。结论:无论采用何种固定方式,尽量达到解剖复位重建足弓,恢复维持足部内外侧纵弓和横弓形态是治疗关键。从生物力学角度分析重建足弓,保证足受力点支架完整性,避免了因足底受力不均而引起的疼痛和破行。跖跗关节和跖骨的解剖复位对足部功能的恢复同样重要。

Objective：To evaluate the therapy and the key metatarsal fracture. Methods：From Jan. 2006 to Jul. 2008,19 points of the tarsometatarsal joint injury combined with patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury,9 cases of tri-column injury. There were 8 cases of shaft fracture,7 of neck fracure, 19 of foundation facture. Results ： All the incisions were first stage healed without skin necrosis. The healing time of fructure was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS,the average score was （84.500±8.553）, the results were excellent in 4 eases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis. Conclusion：No matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.