空心螺钉与锁定钩板治疗第五跖骨Ⅰ、Ⅱ区骨折的比较研究

Comparison of locking compression plate distal ulna hook plate and cannulated screws for fractures of fifth metatarsal base at zones Ⅰ and Ⅱ

目的比较空心螺钉与锁定钩板治疗第5跖骨近端Ⅰ、Ⅱ区骨折的疗效。方法回顾性分析2013年7月至2015年12月收治的67例第5跖骨Ⅰ、Ⅱ区骨折的患者资料，根据治疗方法不同分为空心螺钉组和锁定钩板组，空心螺钉组29例，男17例，女12例；平均46．6岁；骨折按照Lawrence-Botte分区：Ⅰ区13例，Ⅱ区16例。锁定钩板组38例，男20例，女18例；平均33．7岁；Ⅰ区20例，Ⅱ区18例。末次随访时采用患足的疼痛视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）中足评分、术后并发症情况评价术后疗效。结果67例患者术后获51～87周（平均57周）随访。空心螺钉组和锁定钩板组患者在骨折愈合时间[（13．9±1．6）周和（14．2±1．8）周]、末次随访时患足VAS评分（（4．9±1．3）分和（4．8±1．0）分]、AOFAS中足评分[（87．9±3．4）分和（88．6±2．5）分]比较，差异均无统计学意义（P〉0．05）。所有患者术后均达到骨性愈合，均未发生钢板、螺钉断裂等严重并发症。结论空心螺钉与锁定钩板治疗第5跖骨Ⅰ、Ⅱ区骨折均能获得满意疗效，都是行之有效的内固定方法。

Objective To compare the therapeutic effects of locking compression plate distal ulna hook plate （LCP-DUHP） and cannulated screws in the internal fixation for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ. Methods This retrospective study included 67 patients who had been treated for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ from July 2013 through December 2015. Of them, 29 were treated by internal fixation with cannulated screws, including 17 men and 12 women with an average age of 46.6 years. There were 13 zone I fractures and 16 zone Ⅱ fractures according to the Lawrence-Botte partition. The other 38 patients were treated by internal fixation with LCP-DUHP, including 20 men and 18 women with an average age of 33.7 years. There were 20 zone I fractures and 18 zone Ⅱ fractures according to the Lawrence-Botte partition. The therapeutic effects were evaluated at the final follow-ups using visual analogue scale （VAS） for the affected feet, American Orthopaedic Foot and Ankle Society （AOFAS） midfoot scoring system, and incidence of postoperative complications. Results All this series were followed up for 51 to 87 weeks （average, 57 weeks）. There were no significant differences between the cannulated screws group and the LCP-DUHP group in terms of fracture healing time （13.9 ± 1.6 weeks versus 14.2 ±1, 8 weeks）, VAS scores （4.9 ± 1, 3 versus 4.8± 1.0） or AOFAS midfoot scores （87.9 ±3.4 versus 88.6±2.5） （P 〉 0. 05）. Bony union was achieved in all. No implant failure was observed in this series. Conclusion Both LCP-DUHP and cannulated screws can lead to satisfactory therapeutic effects in the treatment of fractures of the fifth metatarsal base at zones I and II.