无头加压螺钉辅助富血小板血浆局部应用治疗陈旧性跖骨头关节内骨折的临床疗效观察

Headless pressure screw with local complication of PRP for the treatment of intra-articular fracture of old metatarsal

目的:探讨采用无头加压螺钉辅助富血小板血浆(platelet-rich plasma,PRP)局部应用治疗陈旧性跖骨头关节内骨折的临床疗效。方法:自2010年1月至2016年6月,采用切开复位无头加压螺钉内固定辅助PRP局部应用治疗7例陈旧性跖骨头关节内骨折患者,其中男5例,女2例;年龄21～52岁;摔伤5例,硬物砸伤2例;受伤时间3～6周。术前行足部X线片及三维CT重建检查,其中第2跖骨2例,第3跖骨2例,第4跖骨3例。术后观察骨折愈合情况,并采用美国足踝骨科协会(AOFAS)足踝评分进行临床疗效评价。结果:7例患者获得随访,时间6～15个月。所有患者伤口达到Ⅰ期愈合,未出现伤口感染、皮瓣坏死、神经血管损伤等软组织并发症。影像学检查均达到骨性愈合,愈合时间3～6个月。7例患者中1例在随访中出现跖趾关节僵硬。AOFAS评分由术前的40.5±4.2提高至术后12个月的85.0±10.5;优4例,良2例,可1例。跖趾关节活动范围:背伸35°～40°,跖屈25°～35°。结论:采用无头加压螺钉内固定辅助PRP局部应用治疗陈旧性跖骨头关节内骨折,可恢复跖骨头关节面平整,提高跖趾关节活动度,促进骨折断端愈合,无须二次手术,配合早期功能锻炼,疗效满意。

Objective：To discuss clinical effects of headless pressure screw with local complication of PRP in treating old metatarsal intra-articular fracture. Methods：From January 2010 to June 2016, 7 patients with old metatarsal intra-articular fracture treated by open reduction headless compression screw internal fixation by local application PRP,including 5 males and2 females,aged from 21 to 52 years old,5 patients injured by falling down and 2 patients caused by crushing,the time from injury to operation ranged from 3 to 6 weeks. Preoperative anteroposterior,lateral and oblique X-ray film and three dimensional CT reconstruction were examined,and the results showed 2 patients on the second metatarsal,2 patients on the third metatarsal,3 patients on the fourth metatarsal. Regular X-ray as postoperative examination was observed,and American Orthopaedic Foot and Ankle Society（AOFAS） ankle scoring system at the final follow up was evaluated. Results：Seven patients were followed up from 6 to 17 months. All incisions healed at stage Ⅰwithout joint stiffness,traumatic arthritis and related complications. Imaging examination showed fracture reached bone healing,healing time ranged from 3 to 6 months. No joint stiffness and traumatic arthritis occurred. One of seven patients occurred stiffness of metatarsophalangeal joints. AOFAS score increased from 40.5±4.2 before operation to 85.0±10.5 at 12 months after operation,and 4 patients got excellent results,2 moderate and 1 poor. The active motion of metatarsophalangeal joint showed dorsal flexion ranged from 35° to 40°,plantar flexion ranged from 25° to 35°. Conclusion：Headless pressure screw with local complication of PRP in treating old metatarsal intra-articular fracture could recover articular surface of metatarsal head,improve metatarsophalangeal joints activity,which do not need the second operation,and could receive good clinical results with early exercise.