新鲜闭合跗中关节骨折脱位的治疗

TREATMENT OF FRESH CLOSED FRACTURE-DISLOCATION OF MIDTARSAL JOINT

目的探讨新鲜闭合跗中关节骨折脱位的治疗方法及疗效。方法 2004年4月-2011年4月,收治73例(75足)新鲜闭合跗中关节骨折脱位,行闭合整复结合切开复位内固定治疗。男56例(58足),女17例(17足);年龄19～62岁,平均35.8岁。高处坠落伤35例,扭伤4例,机器皮带绞伤5例,重物砸伤9例,交通事故伤20例。伤后至入院时间为1 h 30 min～48 h,平均4.5 h。跗中关节损伤根据Main等分型标准:纵向压缩型6足,内侧移位型33足,外侧移位型17足,跖屈型9足,碾压损伤型10足。合并中足骨折脱位34足,舟骨骨折6足,骰骨压缩骨折18足,跟骨骨折8足,距骨骨折7足,胫距关节脱位2足,距下关节脱位2足,内踝骨折1足。合并足急性筋膜室综合征3足。结果术后65例(67足)切口Ⅰ期愈合,8例(8足)Ⅱ期愈合。62例(62足)获随访,随访时间11个月～7年11个月,平均3年6个月。术后26足步行时足部疼痛,36足步行时自觉伤足僵硬或不适。X线片复查示,59足跗中关节骨折脱位及其合并伤均复位良好,无再脱位及骨折不愈合发生;3足发生足舟骨坏死,继发扁平足,均行关节融合术。末次随访时,按照美国矫形足踝协会(AOFAS)标准评价足功能,为77～90分,平均88.6分。结论根据术前对损伤的评估,采用手法整复结合内固定(微型接骨板桥式支撑、空心螺钉联合克氏针内固定)治疗存在不同合并损伤的跗中关节骨折脱位疗效良好。

Objective To investigate the treatment method and effectiveness of fresh closed fracture-dislocation of the midtarsal joint.Methods Between April 2004 and April 2011,73 patients（75 feet） with fresh closed fracturedislocation of the midtarsal joint were treated with closed reduction combined with open reduction and internal fixation.There were 56 males（58 feet） and 17 females（17 feet）,aged from 19 to 62 years（mean,35.8 years）.Injuries were caused by falling from height in 35 cases,by sprain in 4 cases,by machine twist in 5 cases,by heavy pound in 9 cases,and by tra c accident in 20 cases.The time from injury to admission ranged from 1 hour and 30 minutes to 48 hours（mean,4.5 hours）.According to Main＇s classi cation standard,6 feet were rated as vertical compression injury,33 feet as medial displacement injury,17 feet as lateral displacement injury,9 feet as exion injury,and 10 feet as crush injury.Concomitant injuries included midfoot fracture-dislocation（34 feet）,scflaphoid fracture（6 feet）,cuboid bone fracture（18 feet）,calcaneal fracture（8 feet）,talus fracture（7 feet）,tibiotalar joint dislocation（2 feet）,subtalar joint dislocation（2 feet）,medial malleolus fracture（1 foot）,and acute compartment syndrome（3 feet）.Results Healing of incision by rst intention was achieved in 65 cases（67 feet）,by second intention in 8 cases（8 feet）.Sixty-two cases（62 feet） were followed up from 11 months to 7 years and 11 months（mean,3 years and 6 months）.After operation,feet pain occurred in 26 cases,and sti ness or discomfort of the a ected foot in 36 feet when walking.The X-ray examination showed good reduction of fracture-dislocation of the midtarsal joint and concomitant injuries with no re-dislocation or bone nonunion in 59 feet;3 feet had flatfoot secondary to navicular necrosis,and underwent arthrodesis.The American Orthopaedic Foot and Ankle Society（AOFAS） score was 77-90（mean,88.6） at last followup.Conclusion According to the preoperative evaluation of the damage,using the manual reduction combined with internal fixation（mini-plate or hollow screw with Kirschner wire） methods can obtain good effectiveness in the treatment of fracturedislocation of the midtarsal joint.