跖侧钢板重建糖尿病性夏科氏足跖跗关节脱位的临床观察

Clinical observation on plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot

目的 ：探讨采用跖侧钢板重建糖尿病性夏科氏足跖跗关节脱位的临床疗效。方法 ：自2012年4月至2014年12月,采用放置钢板于内侧跖跗关节跖侧重建7例（9足）糖尿病性夏科氏足的跖跗关节脱位患者,均为男性,其中单侧5例,双侧2例;年龄45~52岁,平均48岁;发现糖尿病病史6~15年。术后采用X线片和CT检查评估骨愈合情况,并采用美国足踝外科协会（AOFAS）中足评分标准进行功能评估。结果：所有患者获得随访,时间12~24个月,平均19个月。术后所有患者创口Ⅰ期愈合。术后无感染、内固定无松动或断裂及骨不愈合等并发症发生。术后X线片及CT复查显示骨愈合时间10~20周,平均16周。按照AOFAS评分,优6足,良2足,可1足。结论：采用跖侧钢板重建糖尿病性夏科氏足的跖跗关节,可使跖跗关节获得坚强的支撑,并取得满意的早期临床疗效。

Objective ：To evaluate clinical results of plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot. Methods：Seven patients （9 feet） patients with tarsometatarsal joint dislocations secondary to diabetic charcot foot were treated with plating from April 2012 to December 2014. All patients were male ,and 5 cases were on the unilateral side and 2 cases were on the bilateral sides. The age of patients ranged from 45 to 52 with an average of 48 years old. The history of diabetics was from 6 to 15 years. X-ray and CT were used to evaluate fractures healing,and AOFAS was applied to estimate recovery of joint function. Results：All patients were followed up from 12 to 24 months with an average of 19 months. All incisions were healed at stage I. No infection, loosening and breakage of internal fixation, bone nonunion were found after operation. According to postoperative X-ray and CT results, the time of fracture healing ranged from 10 to 20 weeks with an average of 16 weeks. Six feet got excellent results,2 good and 1 moderate based on AOFAS scoring. Conclnsion：Tarsometatarsal joint dislocations secondary to diabetic charcot foot treated with plate on the metatarsal side could obtain stable fixation and got satisfied early clinical results.