成人骰骨骨折分型及治疗分析

CLASSIFICATION OF ADULT CUBOID FRACTURE AND EFFECTIVENESS ANALYSIS

目的探讨成人骰骨骨折的分型标准及其指导骰骨骨折治疗的可行性及效果。方法回顾2009年5月-2014年4月收治并有完整CT资料的415例(416足)涉及骰骨骨折的成人患者临床资料。男337例,女78例;年龄19~64岁,平均38.8岁。左足220例,右足194例;双足1例。致伤原因:扭伤106例,交通事故伤65例,高处坠落伤129例,重物压伤115例。受伤至入院时间2 h^3 d,平均8.5 h。结合CT检查结果提出骰骨骨折分型标准,并统计治疗方法:285足Ⅰ型、18足Ⅱa型及5足Ⅲ型骨折行外固定保守治疗;41足Ⅱb型及67足Ⅲ型骨折行切开复位内固定,其中58足Ⅲ型骨折复位后采用植骨修复遗留缺损。结果患者均获随访,随访时间1年~5年11个月,平均2年3个月。手术治疗患者术后切口均Ⅰ期愈合。Ⅰ型骨折中165足骨折愈合,愈合时间4~6周,平均5.5周;余120足骨折未愈合。末次随访时根据美国矫形足踝协会(AOFAS)标准评分为95~100分,平均96.7分。Ⅱ型骨折均愈合,愈合时间6~8周,平均6.5周。末次随访时根据AOFAS标准评分为92~100分,平均95.5分。Ⅲ型骨折中,5足保守治疗者于6~8周畸形愈合。67足手术治疗者中,9足骨折复位不充分者术后6~8周畸形愈合,出现足外侧柱短缩,中前足外展畸形、骨关节炎、中足外侧疼痛症状;58足骨折复位充分者术后8~12周愈合,植骨均愈合,无骨关节炎、足外侧柱短缩及骰骨处明显疼痛等并发症发生。末次随访时根据AOFAS标准评分为75~97分,平均93.5分。结论结合CT检查提出的成人骰骨骨折分型标准可行,并对治疗方法的选择具有指导意义。

Objective To study the classification criteria of adult cuboid fracture and its guidance feasibility and effect of treatment. Methods A retrospective analysis was made on the clinical data of 415 adult patients （416 feet） with cuboid fractures who had complete CT data treated between May 2009 and April 2014. There were 337 males and 78 females, aged 19 to 64 years （mean, 38.8 years）. The left foot, right foot, and bilateral feet were involved in 220 cases, 194 cases, and 1 case respectively. The causes of injury were sprain in 106 cases, traffic accident in 65 cases, falling from height in 129 cases, and heavy crushing in 115 cases. The interval of injury and hospitalization was 2 hours to 3 days （mean, 8.5 hours）. Based on CT findings, the classification criteria of cuboid fracture was proposed and methods of treatment was statistically analyzed. The external fixation surgery was performed in patients of type I （285 feet）, type IIa （18 feet）, and type III （5 feet）; open reduction and internal fixation were performed in patients of type IIb （41 feet） and type III （67 feet）, and bone grafting was used to repair defects in 58 feet （type III）. Results All patients were followed up i year to 5 years and 11 months （mean, 2 years and 3 months）. Primary healing of incision was obtained. In patients with type I fracture, fracture healed in 165 feet at 4-6 weeks （mean, 5.5 weeks）, fracture did not heal in the other 120 feet; the American Orthopaedic Foot and Ankle Society （AOFAS） score was 95-100 （mean, 96.7） at last follow-up. In patients with type II fracture, fracture healed in all feet at 6-8 weeks （mean, 6.5 weeks）; the AOFAS score was 92-100 （mean, 95.5） at last follow-up. In patients with type III fracture, malunion was observed at 6-8 weeks in 5 feet undergoing external fixation, and in 9 feet undergoing open reduction and internal fixation with foot lateral column shortening, forefoot abduction deformity, osteoarthritis, lateral foot pain; fracture healed at 8-12 weeks in 58 feet undergoing open reduction and internal fixation, without osteoarthritis, cuboid bone shortening, and pain at cuboid bone; and AOFAS score was 75-97 （mean,93.5） at last foUow-up. Conclusion The classification criteria of cuboid fracture proposed based on CT examination is feasible and has guiding significance to the choice of treatment method.