切开复位内固定治疗多发跖骨基底部不稳定骨折合并跖跗关节损伤

Treatment of multiple base unstable fractures of metatarsal bone combined with tarsometatarsal joint injury by open reduction and internal fixation

[目的]探讨切开复位内固定治疗多发跖骨基底部不稳定骨折合并跖跗关节损伤的方法及临床疗效。[方法]2003年1月～2011年7月,收治35例多发跖骨基底部不稳定骨折合并跖跗关节损伤患者。男22例,女13例;年龄20～58岁,平均37.4岁。均采用切开复位内固定的方法治疗。共89处跖骨基底部骨折,其中第2、3跖骨骨折9例,第3、4跖骨骨折7例,第2、3、4跖骨骨折19例。跖跗关节损伤分型:单纯中间柱损伤2例,内侧柱伴中间柱损伤7例,外侧柱伴中间柱损伤10例,三柱损伤16例。针对第2、3跖骨基底部骨折应用微型钢板跨关节固定。[结果]所有患者均获随访,随访时间12～30个月,平均22.5个月。术后未发生切口感染、皮肤坏死、内固定断裂等并发症。骨折临床愈合时间为8～17周,平均13.9周。按照美国足踝外科协会(AOFAS)中足评分标准,优11例,良18例,一般4例,差2例,优良率82.9%。[结论]跖跗关节和跖骨基底部的解剖复位和可靠固定对足部功能的恢复同等重要,能减少中足骨性关节炎的发生率并取得良好疗效。固定方式的选择应根据损伤类型制定。

[ Objective ] To explore the therapy and the clinical effectiveness of open reduction and internal fixation in the treatment of multiple base unstable fractures of metatarsal bone combined with tarsometatarsal joint injury. [ Method] From January 2003 to July 2001,35 patients with multiple base unstable fractures of metatarsal bone combined with tarsometatarsal joint injuries underwent open reduction and internal fixation. There were 22 males and 13 females with an average age of 37.4 years （range,20- 58 years） ,with total of 89 base fractures. There were 9 cases in the second to third metatarsal bone,7 in the third to fourth metatarsal bone and 19 in the second to fourth metatarsal bone. The classification of tarsometatarsal joint injury showed that there were 2 case of simple middle column,7 cases of inner and middle columns, 10 cases of lateral and middle colums, 16 cases of three columns. The second and third base fractures of metatarsal bone were treated with transarticular fixation by miniplate. ~ Result ] All the patients were followed up, the duration ranged from 12 to 30 months （ averaged 22.5 months）. No complications such as wound infection, skin necrosis and fixture breakage were found postoperatively. The clinical fracture heal- ing time was 8 to 17 weeks （ mean, 13.9 weeks）. The results were excellent in 11 cases, good in 18 cases, fair in 4 cases, and poor in 2 cases according to American Orthopaedic Foot and Ankle Society （AOFAS） midfoot score system,with excellent and good result rate of 82.9%. [ Conclusion] The anatomical reduction and stable fixation of tarsometatarsal joint and metatarsal base are also important to rebuild the function of foot, can reduce incidence rate of osteoarthritis at midfoot and obtain very good clinical effect. Reasonable internal fixation should be selected according to injury type.