微型T形接骨板跨跟骰关节反向内固定治疗骰骨近端关节面压缩骨折疗效观察

Clinical effect of miniature T-plate reversed and across the calcaneocuboid joint fixation in treatment of cuboid compressive fracture of proximal articular surface

目的探讨微型T形接骨板跨跟骰关节反向内固定治疗骰骨近端关节面压缩骨折的疗效。方法回顾性分析自2015-01—2018-12诊治的11例骰骨近端关节面压缩骨折,采用微型T形接骨板跨跟骰关节反向内固定重建骰骨近端关节面及恢复外侧柱长度。术后通过复查X线片与CT评估骨折复位情况,观察患肢功能及并发症发生情况。末次随访时采用Maryland足部评分标准进行功能评价,采用疼痛VAS评分评估患者负重行走时疼痛情况。结果11例均获得随访,随访时间平均16.3(12~25)个月。术后影像学结果显示9例解剖复位,1例矢状位关节面分离约1 mm,1例关节面移位约1 mm。骨折愈合时间平均11.4(8~14)周。末次随访时Maryland足部功能评分平均90.5(76~98)分,其中优8例,良3例;疼痛VAS评分平均0.8(0~4)分。结论采用微型T形接骨板跨跟骰关节反向内固定治疗骰骨近端关节面压缩骨折可有效维持外侧柱长度及复位后的关节面,骨折复位不易丢失,可以有效减少或避免创伤性关节炎的发生。

Objective To investigate the clinical effect of the miniature T-plate reversed and across the calcaneocuboid joint fixation in the treatment of cuboid compressive fracture of the proximal articular surface.Methods The retrospective analysis included 11 cases of cuboid compressive fracture of the proximal articular surface treated from January 2015 to December 2018,with open reduction and T-plate reversed fixation across the calcaneocuboid joint,to reconstruct the proximal articular surface of cuboid and restore the length of lateral column.Post-operative X-ray and CT were reexamined to evaluate the reduction of fracture.The function of the affected limb and the incidence of complications were observed.At the last followup,the clinical effect was evaluated by Maryland foot score,the foot pain when walking was assessed by visual analogue scale(VAS).Results All the patients were followed up for 16.3 months(range,12-25 months).Post-operative X-ray and CT scan results showed that:9 cases achieved anatomical reduction,1 case had sagittal articular surface separation about 1 mm,1 case had about 1 mm displacement of articular surface.Mean healing time was 11.4 weeks(range,8-14 weeks).At the last followup,Maryland score was 90.5 points(range,76-98 points),the outcomes were excellent in 8 cases,good in 3.The average VAS score was 0.8 points(range,0-4 points).Conclusion The miniature T-plate reversed fixation across the calcaneocuboid joint in the treatment of cuboid compressive fracture of the proximal articular surface is effective to maintain the length of the lateral column and the articular surface.It can effectively decrease the reduction loss,reduce or avoid the occurrence of traumatic osteoarthritis.