克氏针有限内固定联合外固定支架治疗跗跖关节骨折脱位的临床研究
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摘要
目的观察克氏针有限内固定联合外固定支架治疗跗跖关节骨折脱位的疗效及其影响因素。方法对2004年1月-2009年6月采用克氏针有限内固定联合外固定支架治疗的患者临床疗效进行回顾性分析,并了解手术时机和韧带损伤情况对远期预后的影响。结果共纳入20例患者,其中男16例,女4例;年龄15~57岁,平均34.7岁;左足9例,右足11例;术后随访11~41个月,平均24.5个月。随访时美国足与踝关节协会踝-后足评分在0~69、70~79、80~89和90~100分者分别有5%(1/20)、10%(2/20)、50%(10/20)和35%(7/20),优良率为85%。患者出院时与最终随访时对治疗结果的接受率分别为95%和85%,差异无统计学意义。此外,手术治疗越早和韧带损伤程度越低患者远期预后越好。结论克氏针有限内固定联合外固定支架治疗不仅可有效恢复关节的功能,而且手术创伤小,是治疗跗跖关节损伤的一种有效方法。
Objective To observe the effi cacy of and infl uencing factors for kirschner wire limited internal fi xation plus external fixation for patients with tarsometatarsal fracture dislocation. Methods The efficacy of kirschner wire limited internal fi xation plus external fi xation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed, and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. Results Twenty patients were included, consisting of 16 male and 4 female patients, ranging from 15 to 57 years old. The mean time of follow-up was 24.5 months, ranging from 11 to 41 months. At the time of follow-up, there were 5%(1/20), 10%(2/20), 50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69, 70~79, 80~89 and 90-100, respectively; and the excellent rate was 85% in total. In this cohort, the acceptance rate of the results of treatment was 95% at discharging and 85% at the fi nal follow-up, and the difference between the above two time-points was not statistically signifi cant. In addition, patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. Conclusion For patients with tarsometatarsal fracture dislocation, treatment with kirschner wire limited internal fi xation plus external fi xation can not only effectively restore joint function, but also has minimum surgical trauma, and it is an effective method for the treatment of tarsometatarsal joint injuries.
Objective To observe the effi cacy of and infl uencing factors for kirschner wire limited internal fi xation plus external fixation for patients with tarsometatarsal fracture dislocation. Methods The efficacy of kirschner wire limited internal fi xation plus external fi xation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed, and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. Results Twenty patients were included, consisting of 16 male and 4 female patients, ranging from 15 to 57 years old. The mean time of follow-up was 24.5 months, ranging from 11 to 41 months. At the time of follow-up, there were 5%(1/20), 10%(2/20), 50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69, 70~79, 80~89 and 90-100, respectively; and the excellent rate was 85% in total. In this cohort, the acceptance rate of the results of treatment was 95% at discharging and 85% at the fi nal follow-up, and the difference between the above two time-points was not statistically signifi cant. In addition, patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. Conclusion For patients with tarsometatarsal fracture dislocation, treatment with kirschner wire limited internal fi xation plus external fi xation can not only effectively restore joint function, but also has minimum surgical trauma, and it is an effective method for the treatment of tarsometatarsal joint injuries.
引文
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[2]Rosenberg GA,Patterson BM.Tarsometatarsal(Lisfranc's)fracturedislocation[J].Am J Orthop(Belle Mead NJ),1995,(Suppl):7-16.
[3]Brinsden MD,Smith SR,Loxdale PH.Lisfranc injury-surgical fixation facilities an early return to work[J].J R Nav Med Serv,2001,87(2):116-119.
[4]赵敦旭.陈旧性跖跗关节脱位的足弓重建[J].中国修复重建外科杂志,2009,23(7):886-887.
[5]梁军,于建华.跗跖关节复合损伤的诊断和治疗[J].中华骨科杂志,2003,23(3):181-183.
[6]张泽坤,赵静品,吴文娟,等.跗跖关节在常规足平片中的影像学表现[J].河北医药,2011,33(7):1003-1005.
[7]杨茂伟,梁单,郭宝磊,等.Lisfranc损伤切开复位内固定术与关节融合术临床疗效的Meta分析[J].中国医科大学学报,2011,40(4):364-367.
[8]Trevino SG,Kodros S.Controversies in tarsometatarsal injuries[J].Orthop Clin North Am,1995,26(2):229-238.
[9]蔡晓冰,纪方,王秋根,等.外固定支架结合有限内固定治疗C型跖跗关节损伤[J].中华创伤骨科杂志,2006,8(12):1188-1189.
[10]徐向阳,刘津浩,朱渊,等.陈旧性跖跗关节骨折脱位[J].中华创伤骨科杂志,2005,7(12):1136-1138.
[11]Rammelt S,Schneiders W,Schikore H,et al.Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal(Lisfranc)fracture dislocation[J].J Bone Joint Surg Br,2008,90(11):1499-1506.
[2]Rosenberg GA,Patterson BM.Tarsometatarsal(Lisfranc's)fracturedislocation[J].Am J Orthop(Belle Mead NJ),1995,(Suppl):7-16.
[3]Brinsden MD,Smith SR,Loxdale PH.Lisfranc injury-surgical fixation facilities an early return to work[J].J R Nav Med Serv,2001,87(2):116-119.
[4]赵敦旭.陈旧性跖跗关节脱位的足弓重建[J].中国修复重建外科杂志,2009,23(7):886-887.
[5]梁军,于建华.跗跖关节复合损伤的诊断和治疗[J].中华骨科杂志,2003,23(3):181-183.
[6]张泽坤,赵静品,吴文娟,等.跗跖关节在常规足平片中的影像学表现[J].河北医药,2011,33(7):1003-1005.
[7]杨茂伟,梁单,郭宝磊,等.Lisfranc损伤切开复位内固定术与关节融合术临床疗效的Meta分析[J].中国医科大学学报,2011,40(4):364-367.
[8]Trevino SG,Kodros S.Controversies in tarsometatarsal injuries[J].Orthop Clin North Am,1995,26(2):229-238.
[9]蔡晓冰,纪方,王秋根,等.外固定支架结合有限内固定治疗C型跖跗关节损伤[J].中华创伤骨科杂志,2006,8(12):1188-1189.
[10]徐向阳,刘津浩,朱渊,等.陈旧性跖跗关节骨折脱位[J].中华创伤骨科杂志,2005,7(12):1136-1138.
[11]Rammelt S,Schneiders W,Schikore H,et al.Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal(Lisfranc)fracture dislocation[J].J Bone Joint Surg Br,2008,90(11):1499-1506.