第五跖骨骨折的手术治疗

Surgical Treatment of Fifth Metatarsal Fractures

目的探讨第5跖骨骨折的手术治疗方法。方法自2003年6月～2006年6月,手术治疗第5跖骨骨折45例,男33例,女12例;年龄18～65岁,平均43.3岁。第5跖骨头颈部骨折9例;骨干骨折17例;Jones骨折6例;基底部撕脱骨折13例。根据AO分型:81(L)-A1型6例,81(L)-B1型13例;81(L)-A2型3例,81(L)-B2型9例,81(L)-C2型5例;81(L)-A3型4例,81(L)-B3型5例。所有患者中4例为开放性骨折。采用的手术方法为切开复位钢板、髓内螺钉或单纯螺钉内固定。其中单纯螺钉固定17例,包括跖骨干部简单斜行骨折3例,跖骨头部简单骨折1例,基底部撕脱性骨折13例;髓内螺钉固定6例,均为Jones骨折;钢板固定22例,包括跖骨干部横行及粉碎性骨折14例,头颈部简单及粉碎性骨折8例。结果 35例随访12～24个月,平均14个月。伤口一期愈合,无感染。骨折愈合时间12～16周,平均13.5周。患者术后平均14周(12～18周)时可完全负重行走,无明显疼痛不适。采用AOFAS中前足评分标准,35例患者评分为74～100分,平均84.3分。结论第5跖骨骨折的解剖复位和确切内固定是维持足部正常形态、恢复足弓功能的关键。

Objective To explore the operative methods of open reduction and fixation for the fifth metatarsal fractures.Methods Fortyfive patients of the fifth metatarsal fractures were treated from June 2003 to June 2006. There were 33 males and 12 females with an average age of 43.3 years old （range from 18 to 65 years）. They included 13 cases of the fifth metatarsal base fractures; 6 of the Jones fractures; 17 of the fifth metatarsal shift fractures; 9 of the fifth metatarsal neck or head fractures. By AO classification, there were 6 cases of 81 （L）-A1, 13 eases of 81 （L）-B1; 3 cases of 81 （L）-A2, 9 cases of 81 （L）-B2, 5 cases of 81 （L）-C2; 4 eases of 81 （L）-A3, 5 cases of 81 （L）-B3. The surgical treatments included open reduction, internal fixation by plate, screw or intramedullary pin. In our group, reduction with pure screw 17 cases, reduction with plate 22 cases, reduction with intramedullary screw 6 cases all of that were Jones fractures. Results Thirty-five patients were followed up for 14 months in average （range from 12 to 24 months）. All of the cases healed well, and the mean time of bone union was 13.5 weeks （range from 12 to 16 weeks）. No infection was found in all cases. The mean time of completely weight loading walking was 14 weeks （range from 12 to 18 weeks）. According to AOFAS the forefoot and midfoot scale, the mean score was 84.3 （range from 74 to 100）. Conclusion Anatomic reduction and stable internal fixation is the best solution for the fifth metatarsal dislocated fracture, which is the key point for recovery of foot form and foot arch function.