带线锚钉缝合固定腓骨肌腱治疗第五跖骨基底部撕脱性骨折

Peroneal tendon insertion and reconstruction by suture anchors for treatment of avulsion fractures of the fifth metatarsal base

目的 回顾分析带线锚钉缝合固定腓骨肌腱治疗第五跖骨基底部撕脱性骨折的临床疗效.方法 5例第五跖骨基底部1区骨折患者（男3例,女2例）,术前平均病程7 d.影像检查发现5例均为第五跖骨基底部1区骨折,骨折块较小、粉碎且明显移位.手术去除第五跖骨基底部粉碎骨折块,游离腓骨肌腱止点,用直径5 mm带线锚钉将腓骨肌腱止点编织缝合在第五跖骨基底部,石膏托将患侧足固定于外翻位.术后6周开始逐渐负重行走.结果 本组5例患者均获随访,随访时间在6个月以上;所有患足外观无畸形.前足主动外翻及外展功能恢复正常,与健侧对比力量无减弱.结论 带线锚钉缝合固定腓骨肌腱治疗第五跖骨基底部撕脱性骨折能较好解决小骨折块固定困难的问题,术后腓骨长短肌腱功能恢复好;手术具有操作简单、剥离范围小、无须二次手术等优点.

Objective To retrospectively analyze the clinical results of peroneal tendon insertion and reconstruction with suture anchors in the treatment of avulsion fractures of the fifth metatarsal base.Methods Five patients （three males and two females） with the fifth metatarsal base fractures were in zone 1, with average seven days of duration before surgery. The result of radiological examination confirmed that all fractures were in zone 1 of the fifth metatarsal base, with some small, comminuted and obviously displaced pieces. After removal of the small comminuted fracture pieces, the peroneal tendon insertion was dissociated and sutured to the fifth metatarsal base by suture anchors （5 mm in diameter） with line. The feet were immobilized by plaster in the vagus position. The patients began to walk with weightbearing six weeks after operation. Results All patients were followed up for at least six months, which showed no deformity of the feet. The function of forefoot valgus and abduction restored to normal. There was no any loss in muscle force compared with the normal side. Conclusions Peroneal tendon insertion and reconstruction by suture anchors is very helpful to solve the problem in the fixation of the small fracture fragments. The function of the peroneal tendon recovers very well. The surgery has the advantages of easy manipulation and small area of dissection, without requirement of secondary surgery.