带线锚钉与Herbert钉治疗第5跖骨基底部Ⅰ区骨折的对比研究
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摘要
目的分别采用带线锚钉与Herbert钉内固定术治疗第5跖骨基底部Ⅰ区骨折患者,对两种内固定手术进行对比研究。方法笔者通过研究2013年1月至2017年12月我院手术治疗的第5跖骨基底部Ⅰ区骨折患者46例,男21例,女25例;年龄17～58岁,平均为(37.9±5.1)岁。根据内固定方式不同分为两组,带线锚钉组24例,Herbert组22例,对比研究两组的手术时间、出血量、术中透视次数、负重时间、骨折愈合时间、骨折移位例数、患足功能恢复情况。结果随访时间12～18个月,平均(14.5±1.6)个月。46例患者切口均正常愈合,未出现切口感染及骨髓炎病例。带线锚钉组病例手术时间(13.0±1.5)min,术中出血量(8.5±3.4)mL,术中透视次数(2.1±1.5)次,开始负重时间(6.1±0.4)周,骨折愈合时间(8.2±0.5)周,骨折移位例数为1例,术后6个月Maryland足功能评(93.2±4.2)分。Herbert钉组病例手术时间(22.0±3.8)min,术中出血量(15.6±5.7)mL,术中透视次数平均(5.0±2.7)次,开始负重时间(8.1±0.5)周,骨折愈合时间(9.2±0.5)周,骨折移位例数为1例,术后6个月Maryland足功能评分(85.2±5.5)分。结论带线锚钉相较于Herbert钉在手术时间、术中出血量、术中透视次数、开始负重时间、骨折愈合时间、踝关节功能方面存在明显优势,而固定的牢固程度却无差异。
Objective To compare the suture anchor and Herbert screw in the treatment of zone I fracture of the fifth metatarsal base.Methods We studied 46 cases of zone I fracture of the fifth metatarsal base treated surgically in our hospital from January 2013 to December 2017,including 21 males and 25 females.The patients aged 17 to 58 years,with an average age of(37.9±5.1).They were divided into two groups according to different internal fixation methods:24 cases in the suture anchor group and 22 cases in the Herbert screw group.The operative time,intraoperative blood loss,intraoperative fluoroscopy frequency,weight bearing time,fracture healing time,fracture displacement cases and functional recovery of the affected foot were compared between the two groups.Results The follow-up period ranged from 12 to 18 months,with an average of(14.5±1.6)months.The incision healed normally in all 46 cases,and no incision infection or osteomyelitis occurred.In the suture anchor group,the operation time was(13.0±1.5)minutes,the amount of bleeding was(8.5±3.4)mL,the number of fluoroscopy was(2.1±1.5)times,the time of beginning weightbearing was(6.1±0.4)weeks,the time of fracture healing was(8.2±0.5)weeks.Thre was 1 case of fracture displacement and the Maryland foot function score was(93.2±4.2)points in 6 months after operation.In Herbert screw group,the operation time was(22.0±3.8)minutes,the amount of bleeding was(15.6±5.7)mL,the number of fluoroscopes was(5.0±2.7)times,the time of starting weight-bearing was(8.1±0.5)weeks,the time of fracture healing was(9.2±0.5)weeks.There was 1 case of displaced fracture,and the Maryland foot function score was(85.2±5.5)points in 6 months after operation.Conclusion Compared with Herbert screw,suture anchor has obvious advantages in operation time,bleeding volume,fluoroscopy frequency,weight-bearing time,fracture healing time and ankle joint function in the treatment of zone I fracture of the fifth metatarsal base,but there is no difference in fixation firmness.
Objective To compare the suture anchor and Herbert screw in the treatment of zone I fracture of the fifth metatarsal base.Methods We studied 46 cases of zone I fracture of the fifth metatarsal base treated surgically in our hospital from January 2013 to December 2017,including 21 males and 25 females.The patients aged 17 to 58 years,with an average age of(37.9±5.1).They were divided into two groups according to different internal fixation methods:24 cases in the suture anchor group and 22 cases in the Herbert screw group.The operative time,intraoperative blood loss,intraoperative fluoroscopy frequency,weight bearing time,fracture healing time,fracture displacement cases and functional recovery of the affected foot were compared between the two groups.Results The follow-up period ranged from 12 to 18 months,with an average of(14.5±1.6)months.The incision healed normally in all 46 cases,and no incision infection or osteomyelitis occurred.In the suture anchor group,the operation time was(13.0±1.5)minutes,the amount of bleeding was(8.5±3.4)mL,the number of fluoroscopy was(2.1±1.5)times,the time of beginning weightbearing was(6.1±0.4)weeks,the time of fracture healing was(8.2±0.5)weeks.Thre was 1 case of fracture displacement and the Maryland foot function score was(93.2±4.2)points in 6 months after operation.In Herbert screw group,the operation time was(22.0±3.8)minutes,the amount of bleeding was(15.6±5.7)mL,the number of fluoroscopes was(5.0±2.7)times,the time of starting weight-bearing was(8.1±0.5)weeks,the time of fracture healing was(9.2±0.5)weeks.There was 1 case of displaced fracture,and the Maryland foot function score was(85.2±5.5)points in 6 months after operation.Conclusion Compared with Herbert screw,suture anchor has obvious advantages in operation time,bleeding volume,fluoroscopy frequency,weight-bearing time,fracture healing time and ankle joint function in the treatment of zone I fracture of the fifth metatarsal base,but there is no difference in fixation firmness.
引文
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[10]Sasaki SU,da Mota e Albuquerque RF,Amatuzzi MM,et al.Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:a mechanical comparison[J].Arthroscopy,2007,23(11):1226-1230.
[2]Niki H,Aoki H,Inokuchi S,et al.Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I:development of standard rating system[J].Orthopaedic Science,2005,10(5):457-465.
[3]Dameron TB Jr.Fractures and anatomical variations of the proximal portion of the fifth metatarsal[J].JBone Joint Surg(Am),1975,57(6):788-792.
[4]Lawrence SJ,Botte MJ.Jones'fractures and related fractures of the proximal fifth metatarsal[J].Foot Ankle,1993,14(6):358-365.
[5]Richli WR,Rosenthal DL.Avulsion fracture of the fifth metatarsal:experimental study of pathomechanics[J].AJR Am J Roentgenol,1984,143(4):889-891.
[6]DeVries JG,Taefi E,Bussewitz BW,et al.The fifth metatarsal base:anatomic evaluation regarding fracture mechanism and treatment algorithms[J].JFoot Ankle Surg,2015,54(1):94-98.
[7]Heineck J,Wolz M,Haupt C,et al.Fifth metatarsal avulsion fracture:a rational basis for postoperative treatment[J].Arch Orthop Trauma Surg,2009,129(8):1089-1092.
[8]Kavanaugh JH,Brower TD,Mann RV.The Jones fracture revisited[J].Bone and Joint Surgery,1978,60(6):776-782.
[9]李利平,曲成明,刘圆圆,等.Herbert螺钉内固定治疗第5跖骨基底骨折[J].实用骨科杂志,2017,23(4):374-376.
[10]Sasaki SU,da Mota e Albuquerque RF,Amatuzzi MM,et al.Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:a mechanical comparison[J].Arthroscopy,2007,23(11):1226-1230.