跖跗关节损伤的手术治疗

Surgical treatment of tarsometatarsal joints injury

目的:总结跖跗关节损伤切开复位内固定的临床经验,评价手术治疗效果。方法:自2009年3月至7月,9例跖跗关节损伤的患者接受切开复位内固定术,其中男7例,女2例;年龄20～47岁,平均33.5岁。损伤按Quenu-Kuss分型:A型5例,B型3例,C型1例。采用1～2个足背纵行直切口,克氏针和空心螺钉内固定。依据美国矫形足踝协会(AOFAS)足评分标准对患足的功能进行评定。结果:9例患者均获得随访,时间5～12个月,平均8个月。术后感染1例,1例发生创伤后关节炎,无克氏针松动。AOFAS总评分由术前的(15.5±4.2)分提高到术后的(92.0±5.2)分(t=-45.95,P<0.01);9例患者中,好7例,较好1例,差1例。结论:切开复位治疗跖跗关节损伤可取得满意效果。

Objective：To summmarize the clincal experience of open reduction and internal fixation for the treatment of tarsometatarsal joint injury ane evaluate the effects of operative treatment to tarsometatarsal joint injury. Methods：From March to July in 2009,9 patients with tarsometatarsal joint injury were treated by open reduction and internal fixation included 7 males and 2 females with an average age of 33.5 years old ranging from 20 to 47 years. According to Quenu-Kuss classifica- tion,there were 5 cases of type A,3 of type B,1 of type C. All patients were treated by cannulated screws and Kirschner wires through 1 to 2 microtubule straight incision on dorsum of foot. The foot function were assessed by American Orthopaedic Foot and Ankle Society （AOFAS） midfoot score. Results：All patients were followed up for 5 to 12 months with an average of 8 months. Complications concluded 1 case with infection,1 case with post-traumatic arthritis. The failure of Kirschner wires was not discovered in 9 cases. According to AOFAS system,the total scores increased from preoperative （15.5±4.2） to postoperative （92.0±5.2） （t=-45.95,P0.01）. The results were excellent in 7 cases,good in 1,and poor in 1. Conclusion：Open reduction and internal fixation for the reatment of tarsometatarsal joint injury should have satisfying results.