锁定加压钩钢板治疗第五跖骨基底部骨折的疗效分析

Curative effect analysis of locking compression plate distal ulna hook plate for fractures of the fifth metatarsal base

目的回顾分析尺骨远端锁定加压钩钢板（locking compression plate distal ulna hook plate,LCPDUHP）治疗第5跖骨基底部骨折的临床疗效。方法 2010年3月至2012年3月,我院采用LCP-DUHP治疗第5跖骨基底部骨折的患者共29例,获完整随访资料者23例,男12例,女11例;年龄20～75岁,平均47岁。损伤骨机制：平地跌伤13例,电瓶车伤5例、交通事故伤3例、高处跌伤2例。所有患者均表现为足外侧肿胀、疼痛、活动受限,无开放性骨折。按照Lawrence-Botte分区：I区者18例,II区5例。从外伤到手术时间为1～5天,平均2天。术后定期随访评估骨折愈合时间、功能恢复、及并发症发生率（如：感染、骨折延迟愈合、骨不连、再折及创伤性关节炎）。功能恢复情况采用美国骨科足踝协会（American orthopaedic foot and ankle society,AOFAS）中足评分标准评定。结果 23例随访11～22个月,平均14个月;所有患者切口均一期愈合;术后部分负重时间3～6周,平均4周;完全负重时间5～16周,平均7周。术后恢复以前生活状态时间8～18周,平均11周。末次随访时,AOFAS中足评分为72～100分,平均94分;其中优19例、良3例、可1例,优良率95.7%。术后即刻X线片显示,骨折均获得满意复位;骨折愈合时间4～16周,平均7.6周,无骨不连及畸形愈合;1例（4.3%）出现延迟愈合,经石膏制动4周后,骨折愈合;末次随访时,3例（13.0%）出现轻度跖骰关节退变。结论 LCP-DUHP治疗第5跖骨基底部骨折可获得满意的临床疗效和影像学结果。

Objective To assess the clinical and radiological outcomes of locking compression plate distal ulna hook plate（ LCP-DUHP） for fractures of the 5th metatarsal base. Methods From March 2010 to March 2012, 29 consecutive patients with fractures of the 5th metatarsal base were treated with LCP-DUHP. There were a total of 23 cases with complete follow-up data. There were 12 males and 11 females, whose mean age was 47 years old（ range： 20-75 years）. As to the mechanism of injuries, falling on the ground occurred in 13 cases, a bicycle accident in 5 cases, a traffic accident in 3 cases and high falling in 2 cases. Preoperatively, all the patients had foot and ankle swelling, pain and restricted movement. No open fractures were noticed. According to Lawrence-Botte, 18 patients had zone I fractures and 5 patients had zone II fractures. The mean period from injury to surgery was 2 days（ range： 1-5 days）. The patients were followed up regularly after the operation, and the time of union, functional recovery and incidence of complications（ such as infection, delayed union, nonunion, refracture and traumatic arthritis） were assessed. The functional outcomes were graded using the American Orthopaedic Foot and Ankle Society（ AOFAS） midfoot scoring system. Results All the 23 patients were followed up for a mean period of 14 months（ range： 11-22 months）. The incisions were primary healing in all the patients. The mean interval to partial weightbearing was 4 weeks（ range： 3-6 weeks）, and the mean interval to full weightbearing was 7 weeks（ range： 5-16 weeks）. All the patients returned to their regular daily lives at a mean period of 11 weeks after the surgery（ range： 8-18 weeks）. In the latest follow-up, the mean AOFAS midfoot score was 94 points（ range： 72-100 points）. The postoperative follow-up data showed excellent outcomes in 19 patients, good outcomes in 3 patients and fair outcomes in 1 patient. The good and excellent rate was 95.7%. Immediately postoperative plain radiographic images showed that satisfactory reduction was achieved in all the patients. Bony union was obtained at a mean period of 7.6 weeks（ range： 4-16 weeks）. No ununion or malunion was found. One patient（ 4.3%） had delayed union, who achieved union at 4 weeks after plaster immobilization. Mild degenerative changes in the plantar and calcaneocuboid joint was detected in 3 patients（ 13.0%） in the latest followup. Conclusions Satisfacoty clinical and radiological outcomes can be achieved in the treatment of fractures of the 5th metatarsal base by LCP-DUHP, and this internal fixation method is worthy of clinical application.