足舟状骨体骨折脱位合并骰骨骨折的治疗

Navicular fracture and dislocation combined with cuboid fracture： a clinical analysis of 17 cases

目的探讨足舟状骨体骨折脱位合并骰骨骨折的治疗方法与临床疗效。方法对2005年3月至2010年3月收治的17例闭合性足舟状骨体骨折脱位合并骰骨骨折患者的临床资料进行回顾性研究；男12例，女5例；年龄17—63岁，平均40岁。舟骨骨折按照Sangeorzan分型：Ⅱ型5例，Ⅲ型12例，骰骨骨折按照AO分型：C1型3例，c2型14例。17例均在2～7d（平均4．5d）内择期行切开复位内固定。根据骨折类型分别选择不同的内固定材料。结果17例患者术后获2个月至5年（平均1．5年）随访。采用Maryland评分标准评定疗效：优4例，良6例，可5例，差2例，优良率为58．8％。差的2例患者中1例发生创伤性关节炎，导致日常活动明显受限，二期行关节融合术；1例术后发生骨不连，行走时有疼痛感，二期行游离骨片摘除术。结论尽早选用恰当的手术方案、早期功能锻炼、较晚负重，是提高此类骨折疗效的关键。

Objective To explore clinical management of the navieular fracture and dislocation combined with cuboid fracture. Methods A retrospective study was done to analyze the 17 cases of closed navicular fracture and dislocation combined with euboid fracture who had been treated from March 2005 to March 2010 in our hospital. They were 12 men and 5 women, aged from 17 to 63 years （mean, 40 years）. By Sangeorzan classification for navicular fractures, there were 5 cases of type II and 12 cases of type III; by AO classification for cuboid fractures, there were 3 cases of type C1 and 14 cases of type C2. Open reduction and internal fixation was performed for the 17 cases in 2 to 7 days （average, 4. 5 days） . Specific fixations were used according to the specific fracture type and early functional exercises were encouraged. Results All the patients in this group were followed up from 2 months to 5 years （average, 1.5 years）. By the Maryland scoring system, 4 cases were rated as excellent, 6 cases as good, 5 cases as fair and 2 cases as poor. The excellent to good rate was 58.8%. Traumatic arthritis occurred in one poor case who had to sustain secondary arthrodesis because of limitation of motion in daily activities; nonunion occurred in the other poor case who had to sustain secondary removal of free bone flaps because of pain in walking. Conclusion In treatment of navicular fracture and dislocation combined with cuboid fracture, an appropriate surgical strategy as early as possible, early functional exercise and late weight-bearing may lead to a satisfactory outcome.