尺骨远端锁定加压钩钢板治疗第五跖骨基底部骨折的初步研究

Distal ulna locking compression hook plate used as an alternative fixation for the fifth metatarsal base fracture

目的探讨应用尺骨远端锁定加压钩钢板治疗第5跖骨基底部骨折的短期疗效。方法2011年10月至2012年1月对17例第5跖骨基底部骨折行切开复位足骨远端锁定加压钩钢板内固定治疗，其中男6例，女11例；年龄22～72岁．平均35．8岁；按照Lawrence和Botte解削分区：I区14例，Ⅱ区3例；撕脱骨折块存在旋转移位大于2mm，或波及跖骰关节面骨块移位。结果15例患者术后获24～64周（平均28周）随访。所有患者术后均未发生切口感染、螺钉断裂及骨折复位丢失等并发症。x线片示骨折愈合时间平均为84d（70～118d）。疗效根据美国足踝外科协会的中足评分标准坪定为76～91分，平均87．4分。手术至恢复日常工作生活时间为91～137d，平均104d。结论应用尺骨远端锁定加压钩钢板治疗第5跖骨基底部I、Ⅱ区骨折，其管型配合弓齿设计能有效加压固定第5跖骨粗隆部，纠正旋转移位，维持第5跖骨基底部骨折准确复位。

Objective To evaluale tile surgical treatment of the fifth metatarsal base fracture using distal ulna locking compression hook plate （DULCHP） . Methods From October 2011 to November 2012, 17 palients with fracture of the fifth metatarsal base were treated with open reduction and internal fix- atiun with DULCHP. They were 6 alert and 11 women, aged from 22 to 72 years （mean, 35.8 years）. Acording to the Lawrence and Botte classification uf anatomic zones, 14 cases had fracture in zone 1 and 3 in zone II. An initial fracture displacement more than 2 mm and significant disruption of the cuboid-fiflh metatarsal joint were involved in the avulsion fractures. Results Fifteen patients were tbllowed up tor an average of 28 weeks （range, from 24 to 64 weeks）. No infection, screw breakage or reduction toss occurred in this series postoperatively. The mean time to complete anion as determined by X-ray ranged from 70 to 118 days （mean, 84 days）. By the American Orthopaedic Foot and Ankle Society （AOFAS） midfoot scale, the therapeutic efficacy scored 87.4 points on average （range, 76 to 91 points）. All patients reported returning to prior activities of daily living at a mean time of 104 days （range, 91 to 137 days） . Conclusion DULCHP fixation is an effective alternative surgical method for displaced fraetures of the fifth metatarsal base at zones I and II, because its mini-hnok tubular plate is so designed that the last hole can function as a hook for applying compression force, grasping comminuted fragments, and maintaining rotational stabilization of the metatarsal base fracture.