内固定治疗复杂中足损伤合并踝关节骨折的疗效分析

Efficacy of internal fixation in the treatment of complex middle foot injury complicated with ankle fracture

目的分析内固定治疗复杂中足损伤合并踝关节骨折的疗效及治疗要点。方法回顾性分析2012年5月—2019年2月福建省立医院27例合并踝关节骨折的复杂中足损伤患者,男性17例,女性10例;年龄36~82岁,平均57.4岁;高处坠落伤7例,道路交通伤8例,步行损伤2例,重物砸伤10例。遵照先固定踝关节后足部顺序,由近到远固定跗横关节、跗中关节、跖跗关节,由内到外依次固定足内、中、外侧柱,恢复足踝解剖结构,术后定期随访,拍摄足踝X线片,采用AOFAS中足评分表及踝-后足评分表对足踝功能进行疗效评价。结果术后随访12~22个月,平均17.3个月。根据AOFAS中足及踝-后足评分表,本组患者中足评分优良率为70.37%,踝-后足评分优良率为66.67%。4例术后切口愈合欠佳并发感染,返院予清创抗感染治疗;2例出现术后螺钉松动,返院取出松动螺钉。未出现骨不连、内植物异物反应等其他术后并发症。结论对于合并踝关节骨折的复杂中足损伤,了解其损伤机制、损伤病理及分型,采取有效内固定能获得良好解剖复位及较好的术后功能康复。

Objective To analyze the curative effect and main points of internal fixation in the treatment of complex middle foot injury complicated with ankle fracture.Methods A total of 27 patients with complex middle foot injury complicated with ankle fracture in Fujian Provincial Hospital from May 2012 to Feb.2019 were retrospectively analyzed.There were 17 males and 10 females,with an average age of 57.4 years(range,36 to 82 years),There were 7 cases of high falling injury,8 cases of traffic accident injury,2 cases of walking injury and 10 cases of crash injury.Patients were treated following the order of fixing the ankle joint first and then the foot,fixing the transverse tarsal joint,middle tarsal joint first,and then tarsometatarsal joint,fixing the inner,middle first,and then lateral columns of the foot from the inside to the outside to restore the ankle anatomy.Ankle X-rays were taken,and the AOFAS midfoot score and ankle-hindfoot score were used to evaluate the effect of ankle function.Results The patients were followed up for 12 to 22 months(mean 17.3 months).According to the AOFAS midfoot and ankle-hindfoot score,the excellent and good rate of midfoot score in this group was 70.37%,and the excellent and good rate of ankle-hindfoot score was 66.67%.Four cases had poor wound healing complicated with infection,2 cases had postoperative screw loosening;the infected patients were treated with debridement and anti-infection,and patients with loose screws were recalled to remove loosing screws.There was no other postoperative complication such as bone nonunion or foreign body reaction.Conclusion For the complex middle foot injury combined with ankle fracture,understanding the injury mechanism,trauma pathology and classification,and performing effective internal fixation can obtain good anatomical reduction and good postoperative functional rehabilitation.