闭合复位组合式微型外固定支架治疗多发跖骨颈骨折

Treatment of multiple metatarsal neck fractures with closed reduction and combined type miniexternal fixator

目的探讨采用闭合复位组合式微型外固定支架固定治疗多发跖骨颈骨折的方法及临床疗效。方法回顾性分析2013年10月至2015年12月中国人民解放军中部战区总医院采用闭合复位组合式微型外固定支架治疗的15例多发跖骨颈骨折病人的临床资料,其中男11例,女4例;年龄为(38.8±11.3)岁(19~61)岁;右侧9例,左侧6例;其中闭合性损伤8例,GustiloⅠ型开放性骨折5例,GustiloⅡ型开放性骨折2例。术中采用组合式微型外固定支架固定,闭合复位骨折,透视确认复位质量。术后记录骨折愈合时间以及并发症情况(包括感染、固定钉松动或断裂、骨延迟愈合与不愈合);术后通过X线片及CT三维重建评估骨折愈合情况。末次随访依据美国足踝医师协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分标准进行术后功能评价。结果本组15例病人随访时间为(16.7±3.1)个月(12~24个月)。1例GustiloⅡ型病人术后8周外固定针松动,后期遗留轻度跖骨短缩畸形,其余未观察到感染、固定针松动及断裂、畸形愈合等。依据AOFAS评定标准:优6例,良7例,可1例,差1例,优良率为86.7%。结论闭合复位组合式微型外固定支架治疗多发跖骨颈骨折,可以获得较理想的复位,并发症较少。

Objective To investigate the method and clinical efficacy of closed reduction and combined type mini external fixator for the treatment of multiple metatarsal neck fractures.Methods The clinical data of 15 patients with multiple metatarsal neck fractures treated with closed reduction and combined type miniature external fixator in Central Theater General Hospital of PLA from October 2013 to December 2015 were retrospectively analyzed.There were 11 males and 4 females,aged(38.8±11.3)years(19⁃61 years).There were 9 cases on the right side,6 cases on the left side,there are 8 of closed fractures,5 cases of GustiloⅠopen fractures,and 2 cases of GustiloⅡopen fractures.During the operation,the combined type miniature external fixator was used to fix the fractures,and the quality of the reduction was confirmed by fluoroscopy.The fracture healing time and complications(including infection,fixation wire loosening or fracture,delayed bone healing and non⁃union)were recorded postoperatively.The fracture quality was evaluated by X⁃ray and CT three⁃dimensional reconstruction.The final follow⁃up was based on the association of American Orthopedic Foot and Ankle Society(AOFAS)mid and forefoot scores for postoperative functional evaluation.Results Fifteen patients were followed up for(16.7±3.1)months(12⁃24 months).One patient with Gustilo typeⅡopen fractures had loose fixation wire 8 weeks after operation,with mild shortened malunion in the last stage.No infection,fixation wires loosening and break,and malunion were observed in the remaining patients.According to the AOFAS assessment criteria,excellent effects were obtained in 6 cases,good in 7 cases,fair in 1 case,and poor in 1 case,with the excellent and good rate being 86.7%.Conclusion Closed reduction and combined type mini external fixator for the treatment of multiple metatarsal neck fractures can achieve a better reduction and fewer complications.