横向双“8”字张力带技术在第五跖骨基底部LawrenceⅠ区骨折中的应用研究

Effectiveness of transverse double“8”-shaped tension band technique for Lawrence zoneⅠfracture of the fifth metatarsal base

目的探讨横向双“8”字张力带技术治疗第5跖骨基底部LawrenceⅠ区骨折疗效。方法2019年2月—2021年10月,对15例第5跖骨基底部LawrenceⅠ区骨折采用横向双“8”字张力带技术治疗。男8例,女7例;年龄23~59岁,中位年龄40岁。致伤原因均为扭伤。受伤至手术时间3~7 d,平均4.1 d。术后X线片复查骨折愈合情况以及锚钉有无松动、脱出,应用美国矫形足踝协会(AOFAS)评分、疼痛视觉模拟评分(VAS)及跟距关节外翻角度评价患足功能。结果术后14例切口Ⅰ期愈合,1例切口愈合不良。患者均获随访,随访时间8~12个月,中位时间10个月。影像学复查示骨折均愈合良好,愈合时间10~14周,平均11.7周。末次随访时,AOFAS评分为82~100分,中位数98分;其中优13例、良2例,优良率100%。VAS评分0~3分,中位数1分。12例踝关节活动恢复正常,3例轻度受限;跟距关节外翻角度25°~32°,中位数30°。结论应用横向双“8”字张力带技术治疗第5跖骨基底部LawrenceⅠ区骨折,具有操作简便、避免二次手术、减少异物感等优势,临床疗效确切。

Objective To explore the effectiveness of transverse double“8”-shaped tension band technique in the treatment of Lawrence zoneⅠfracture of the 5th metatarsal base.Methods Between February 2019 and October 2021,15 patients with Lawrence zoneⅠfracture of the 5th metatarsal base were treated with transverse double“8”-shaped tension band technique.There were 8 males and 7 females,with a median age of 40 years(range,23-59 years).The fractures were caused by sprains.The time from injury to operation was 3-7 days(mean,4.1 days).X-ray films were taken to observe the fracture healing and the anchor looseness and detachment.The foot function was evaluated by American Orthopaedic Foot and Ankle Society(AOFAS)score,visual analogue scale(VAS)score,and the eversion angle of the calcaneal talus joint.Results The incisions healed by first intention after operation in 14 cases and the incision healed poorly in 1 case.All patients were followed up 8-12 months(median,10 months).The imaging examination showed that all fractures healed well,with a healing time of 10-14 weeks(mean,11.7 weeks).At last follow-up,AOFAS score was 82-100(median,98);13 cases were excellent and 2 cases were good,with an excellent and good rate of 100%.VAS score was 0-3(median,1).Three cases had mild limited ankle joint range of motion,while 12 cases had normal range of motion.The eversion angle of the calcaneal talus joint was 25°-32°(median,30°).Conclusion The application of transverse double“8”-shaped tension band technique for Lawrence zoneⅠfracture of the 5th metatarsal base has advantages such as simple operation,avoidance of secondary operation,and reduction of foreign body sensation,with definite effectiveness.