钩钢板与空心螺钉固定第五跖骨基底Ⅰ区骨折的比较

Interlocking compression hook plate versus cannulated screw for internal fixation of zone Ⅰ proximal fifth metatarsal fracture

[目的]比较钩钢板与空心螺钉治疗第五跖骨基底Ⅰ区骨折的临床疗效。[方法] 2015年1月—2018年4月,本科手术治疗第5跖骨基底部Ⅰ区骨折患者32例,依据术前医患沟通结果,将患者分为两组。其中,16例采用开放复位钩钢板内固定(钩板组),16例采用空心螺钉固定(螺钉组)。比较两组围手术期、随访与影像资料。[结果]所有患者均顺利手术,无严重并发症。腓肠神经损伤钩钢板组1例,螺钉组2例,给予神经营养药物,无严重不良后果。钩板组的手术时间、切口总长度、术中失血量均显著大于螺钉组,差异有统计学意义(P<0.05)。随访时间12~15个月,平均(13.32±1.65)个月。钩板组恢复下地行走和完全负重活动时间均显著早于螺钉组(P<0.05)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而AOFAS中前足评分显著增加(P<0.05)。术后3个月时和末次随访时,两组间VAS和AOFAS评分的差异均无统计学意义(P>0.05)。影像方面,钩板组骨折复位质量与螺钉组的差异无统计学意义(P>0.05),钩板组骨折愈合时间显著早于螺钉组(P<0.05)。[结论]与螺钉相比,钩钢板固定第五跖骨基底Ⅰ区骨折可靠性更高,更有利于骨折愈合和功能恢复。

[Objective] To compare the clinical efficacy of interlocking compression hook plate versus headless cannulated screw for internal fixation of zone I proximal fifth metatarsal fracture. [Methods] From January 2015 to April 2018, 32 patients underwent surgical treatment for zone I proximal fifth metatarsal fracture in our hospital. According to the results of preoperative doctor-patient communication, the patients were divided into two groups. Of them, 16 patients received open reduction and internal fixation with the hook plate(the hook plate group), while the other 16 patient had fracture fixed with a cannulated screw(the screw group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients underwent operation smoothly without serious complications. Sural nerve injury happened in 1 case of the hook plate group, whereas 2 cases of the screw group, which cured after neurotrophic drugs given without serious adverse consequences. The hook plate group consumed significantly longer operation time, associated with significantly greater total incision length and intraoperative blood loss than the screw group(P<0.05). The follow-up period lasted for 12~15 months with an average of(13.32±1.65) months. The hook plate group returned to walking and full weight-bearing activities significantly earlier than the screw group(P<0.05). The VAS scores decreased significantly(P<0.05), while the AOFAS midfoot scores increased significantly over time in both groups(P<0.05). However, at 3 months after operation and at the last follow-up there were no significant differences in VAS score and AOFAS score between the two groups(P>0.05). In terms of imaging assessment, there was no significant difference in the quality of fracture reduction between the two groups(P>0.05), however, fracture healing time in the hook plate group was significantly earlier than that in the screw group(P<0.05). [Conclusion] Compared with screws, the hook plate used for internal fixation of the zone I proximal fifth metatarsal fracture is more reliable, and is more conducive to fracture healing and functional recovery.