纸板加压垫与短腿石膏托治疗第5跖骨基底骨折病例对照研究

Case-control study on the treatment of the fifth metatarsal base fractures by cardboard compression pad versus short leg plaster

目的：探讨纸板加压垫治疗第5跖骨基底骨折的疗效、安全性及优势,建立纸板加压垫疗法治疗第5跖骨基底骨折的诊疗规范.方法：自2010年6月至2013年3月,采用纸板加压垫或短腿石膏外固定治疗新鲜第5跖骨基底骨折患者59例.随机纳入到纸板组或石膏组,纸板组29例,男9例,女20例,平均年龄（51.79±11.40）岁,平均病程（11.59±6.58）h.石膏组30例,男9例,女21例,平均年龄（52.13±17.34）岁,平均病程（11.03±7.06）h.根据骨折线分型：纸板组A型骨折14例,B型骨折15例;石膏组A型骨折16例,B型骨折14例.根据骨折移位分级：纸板组Ⅰ度移位16例,Ⅱ度移位13例;石膏组Ⅰ度移位20例,Ⅱ度移位10例.根据骨折分型采取相应的手法进行整复,纸板组给予纸板加压垫治疗,石膏组给予短腿石膏外固定,固定时间均为4～6周.于固定后第2、4、6、8周,3、6个月进行随访,采用足部功能评分量表评价患足功能,其中第2、4、6、8周时拍摄患足正斜位X线片,对X线骨折线和骨折边缘情况进行评分比较.结果：所有患者完成随访,治疗后8周,骨折均达临床愈合,没有压疮、骨折不愈合、骨折端移位等不良事件发生.治疗后4～8周,纸板组X线评分高于石膏组,但组间差异无统计学意义.重复测量分析结果显示,不同时间点间及各时间点两组间具有交互作用,差异有统计学意义（P＜0.001）.治疗后各时间点,纸板组足部功能评分均高于石膏组,其中在治疗后2、4、6周,组间差异具有统计学意义（P＜0.01）.治疗后6个月,纸板组优良率93.10％,优于石膏组的86.67％,但差异无统计学意义（P=-0.483）.结论：纸板加压垫的方法治疗第5跖骨基底骨折,具有操作简单、固定可靠、取材方便、费用经济、疗效满意等优点,是一种简便验廉的治疗方法.

Objective：To compare the effect,safety,and advantage of flexible fixation with paperboard and pad versus short leg plaster in treating the fifth metatarsal base fracture,and establish the standard of diagnosis and treatment of the fifth metatarsal base fractures in flexible fixation with paperboard and pad.Methods：From June 2010 to March 2013,59 patients with the fifth metatarsal base fracture were treated with paperboard and pad fixation or short leg plaster.Patients were enrolled and divided into paperboard and pad treatment group （paperboard group） and short leg plaster treatment group （plaster group） randomly according to the random number table.In paperboard group,there were 29 cases including 9 males and 20 females with an average age of （51.79t11.40） years old; the average course of injury was （11.59t6.58） hours.In plaster group,there were 30 cases including 9 males and 21 females with an average age of （52.13t17.34） years old;the average course of injury was （11.03±7.06） hours.According to whether the fracture line across the articular surface,in paperboard group there were 14 cases of type A,15 of type B ;in plaster group,16 of type A,14 of type B.According to the degree of dislocation,in paperboard group there were 16 cases of degree Ⅰ,13 of degree Ⅱ ; in plaster group,20 were degree Ⅰ,10 were degree Ⅱ.Fracture was restored according to the type in manual.Patients in paperboard group were treated with paperboard and pad,and patients in plaster group were treated with short leg plaster.Fracture was fixed for 4 to 6 weeks according to fracture healing.On the 2nd,4th,6th,8th week and 3rd,6th month after fixation,patients were followed up,and the foot function score was used to evaluate the function of injured foot.X-ray of injured foot was taken on the 2nd,4th,6th and 8th week were used to assess fracture healing.Results：All patients got complete follow-up.The X-ray result showed that all fracture reached at clinical healing on the 8th week after fixation without skin ulcer,nonunion and displacement of fracture.From the 4th to 8th week after fixation,paperboard group had a higher X-ray score than plaster group,but the difference between two groups had no statistically significance.Repeated analysis result showed that there was interact at different time point and between groups,the difference had statistically significance （P＜0.01）.The foot function score showed that at all time point,paperboard group had a higher score than plaster group,and on the 2nd,4th,and 6th week,it had statistically significant difference （P＜0.01） between two groups.On the 6th months after fixation,the excellent and good rate of paperboard group was 93.10％,higher than that of plaster group,which was 86.67％.But it had no statistically difference （P=0.483） between two groups.Conclusion：Using paperboard and pad fixation to treat the fifth metatarsal base fracture has the advantage of simplicity operating,reliable fixation,satisfactory effects,easily obtainable material.