切开复位内固定术对跖骨基底部粉碎性损伤患者术后康复及足踝功能的影响

Effect of open reduction and internal fixation on postoperative rehabilitation and ankle function in patients with base crushing injury of metatarsal bone

探讨切开复位内固定术对跖骨基底部粉碎性损伤患者术后康复及足踝功能的影响。方法 选取2014年2月至2016年8月本院69例跖骨基底部粉碎性损伤患者，按照随机数表法分为观察组（n=35）与对照组（n=34）。对照组行关节融合术，观察组行切开复位内固定术。对比两组手术及术后恢复情况、手术前及术后6个月足踝功能（AOFAS足评分），两组均随访至术后12个月，统计对比两组术后并发症发生率。结果 观察组手术用时[（44.26±7.18）min比（52.91±6.47）min]、住院时间[（15.62±1.47）d比（19.24±3.25）d]较对照组短，术中出血量[（281.36±62.21）ml比（357.23±59.34）ml]较对照组少（P＜0.05）；两组AOFAS足评分手术前比较[（57.26±5.16）比（56.83±6.21）]差异无统计学意义（P＞0.05），术后6个月较手术前均有提高（P＜0.05），且观察组较对照组[（89.48±4.44）比（77.63±5.38）]高（P＜0.05）；观察组术后并发症发生率与对照组比较[8.57%（3/35）比23.53%（8/34）]差异无统计学意义（P＞0.05）。结论 切开复位内固定术治疗跖骨基底部粉碎性损伤疗效显著，术后康复较快，且有利于改善患者足踝功能。

To investigate the effect of open reduction and internal fixation on postoperative rehabilitation and ankle function in patients with base crushing injury of metatarsal bone.Methods 69 cases of base crushing injury of metatarsal bone in our hospital from February 2014 to August 2016 were randomly divided into the observation group(n=35)and the control group(n=34).The control group was treated with arthrodesis,while the observation group was treated with open reduction and internal fixation.The operation and postoperative recovery,ankle function(AOFAS foot score)before and 6 months after operation were compared between the two groups.The two groups were followed up for 12 months after operation,and the incidence of postoperative complications was compared between the two groups.Results The operation time and hospitalization time of the observation group were shorter than those of the control group[(44.26±7.18)min vs.(52.91±6.47)min,(15.62±1.47)d vs.(19.24±3.25)d],and the amount of intraoperative bleeding was less than that of the control group[(281.36±62.21)ml vs.(357.23±59.34)ml](P<0.05).There was no statistically significant difference in AOFAS foot score between the two groups[(57.26±5.16)points vs.(56.83±6.21)points](P>0.05);6 months after operation,AOFAS foot score improved in both two groups(P<0.05),and that of the observation group was higher than that of the control group[(89.48±4.44)points vs.(77.63±5.38)points](P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the observation group[8.57%(3/35)]and the control group[23.53%(8/34)](P>0.05).Conclusion Open reduction and internal fixation has significant curative effect in the treatment of base crushing injury of metatarsal bone,which can make the postoperative recovery rapid,and is beneficial to improve the ankle function.