解剖型锁定接骨板结合植骨支撑治疗骰骨粉碎骨折

Anatomical locking plate combined with bone graft support for comminuted cuboid fractures

[目的]观察解剖型锁定接骨板结合植骨支撑治疗骰骨粉碎骨折的临床及影像学效果。[方法]回顾性分析2013年7月~2017年3月在本科应用解剖型锁定接骨板结合植骨支撑治疗的骰骨粉碎骨折患者15例,男9例,女6例,年龄21~65岁,平均(48.05±12.15)岁。使用Maryland足部评分和美国足踝外科协会AOFAS中足评分进行临床功能评价,行影像检查,测量站立位X线片上骰骨长度(L)、高度(H)、宽度(W)以及外侧纵弓角(LA)、跟骨第五跖骨角(CM)的数据,并与健侧足进行比较。[结果]所有患者均顺利完成手术,无严重并发症。所有患者均获得2.12~5.84年随访,平均随访时间(3.42±1.63)年,末次随访Maryland足部评分(92.74±3.82)分、美国足踝外科协会AOFAS中足评分(91.81±4.62)分,与术前相比,差异有统计学意义(P<0.05)。影像方面,随访中未出现足弓塌陷及前足外展畸形。末次随访伤侧骰骨平均长度(31.41±1.14) mm、高度(30.69±2.20) mm、宽度(24.59±2.57) mm、外侧纵弓角(137.21±4.81)°、跟骨第五跖骨角(12.49±0.48)°,与健侧骰骨比较差异无统计学意义(P>0.05)。[结论]解剖型锁定接骨板结合植骨支撑治疗粉碎性骰骨骨折可实现解剖复位,足部稳定,功能良好。

[Objective] To observe the clinical outcomes of open reduction and internal fixation with an anatomical locking plate combined with bone graft support for comminuted cuboid fractures. [Methods] A retrospective study was conducted on 15 patients who underwent open reduction and internal fixation with anatomical locking plate combined with bone graft support for comminuted cuboid fractures from July 2013 to March 2017, involving 9 males and 6 females aged 21-65 years with an average age of(48.05+12.15) years. The Maryland foot score and AOFAS midfoot score were used to evaluate the clinical consequences.In addition, the length(L), height(H), width(W), lateral longitudinal arch angle(LA), calcaneal fifth metatarsal angle(CM) of the cuboid were measured on the standing X-ray films, and compared with those of contralateral healthy foot. [Result] All patients had operations performed successfully without serious complications. The follow up period lasted for 2.1~5.8 years with a mean of(3.42±1.63) years. The Maryland foot score was of(92.74±3.82), while the AOFAS midfoot score of(91.81±4.62) at the latest follow up, which significantly increased compared with those before operation(P<0.05). Regarding radiographic assessment, no collapse of foot arch or abduction deformity of forefoot was found on images in anyone of them to the latest follow up.The affected cuboid was radiographically measured(31.41±1.14) mm in length,(30.69±2.20) mm in height and(24.59±2.57)mm in width, associated with lateral longitudinal arch angle of(137.21±4.81)° and calcaneus-5 thmetatarsal angle of(12.49±0.48)° at the latest follow up, which proved no statistical differences compared with the contralateral uninvolved cuboid(P>0.05). [Conclusion] This ORIF with anatomical locking plate combined with bone graft support does achieve anatomical reduction, recovers a stable foot with good function for comminuted cuboid fracture.