开放性跖跗关节损伤的治疗  

Treatment of open to the tarsometatarsal joint injury

作　　者：顾文奇[1] 施忠民[1] 柴益民[1] 

机构地区：[1]上海交通大学附属第六人民跃院创伤骨科,200233

出　　处：《中华创伤骨科杂志》2012年第9期748-751,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：【摘要】目的探讨开放性跖跗关节损伤的治疗办法及疗效。方法2009年4月至2010年4月收治14例外放性跖跗关节损伤患者，男10例，女4例；年龄21～67岁，平均45岁；根据Chiodo和Myerson提出的三柱分型，均为三柱损伤，合并内侧柱或外侧柱短缩的患者（各2例）辅以微型外固定支架固定；皮肤软组织缺损行（2例）缺损区清创后予负压封闭引流（VSD）敷料覆盖；合并皮肤脱套者（1例）扣薄脱套皮肤后原位回析，并用VSD敷料覆盖；软组织条件改善后，均二期更换内固定或同时行软组织覆盖，术后采用美国足踝外科协会（AOFAS）中足评分系统评定疗效。结果1例脱套伤患者出现部分回植皮肤坏死，于急诊术后第13天行清创、更换内固定及局部皮瓣转位修复术；2例皮肤软组织缺损者分别手术后第7、11天更换内固定及创面植皮覆盖。12例患者术后平均随访18个月（13～25个月），二期水后平均12周（10—16周）骨性愈合。未发生皮瓣坏死、感染、骨不连、骨髓炎等并发疵，2例跖跗关节复合体损伤患者因创伤性关节炎致疼痛及功能严重受限．分刖于术后12和14个月行跖跗关节融合术，所有患哲未次随访AOFAS中足评分平均为72分（61～89分）。结论开放性跖跗关节损伤早期要对创面彻底消创，复位骨折脱化、恢复足部力线后临时酬定，待软组织条件改善后择期更换内固定，可获得骨折脱位的稳定固定，是一种安全有效的治疗方法。Objective To discuss the treatment and clinical outcome of open to the tarsnmetatarsal joint injury. Methods From April 2009 to April 2010, 14 patienls, 10 males anti 4 females, with open to the tarsnmetatarsal joint injnry were treated in our department. They were 45 years old on average （frmn 21 to 67 years old）. Five of them had the tarsumetatarsa] complex involved. According to Chiodo and Myerson＇s classification, all the injuries were of three-colunm type. Medial and lateral column shortening was respectively, concomitant in 2 cases. Two patients had combined soft lissue defects and one patient degloved dorsal skin. A thorougil debridement and Kirschner wire fixation following reduction were perfnrmed fro all patients in the emergency room. A mini external fixator was applied in patients with medial or lateral column shortening. The degloved skin was thinned and grafted in situ, followed by vacuum sealing drainage （VSD） to cover the wound. The soft tissue defect was covered by VSD after debridement. All the patients had a definitive internal fixation after the soft tissue condition improved, and 3 of them had soft tissue coverage simultaneously. Functional outcomes were sem＇ed by American Orthopedic Font Ankle Society （AOFAS） system. Results One patient with degloving injury had partial skin necrosis which was treated by debridement, definitive internal fixation and local flap transfer on the 13th day after emergency operation. A definitive internal fixation and skin graft were performed in 2 patients with soft tissue detects respectively on the 7th or l lth day posl-operation. No wound infection or necrosis oeearred in other patients. Twelve patients were followed up for an average period of 18 months （frnm 13 to 25 months）. Solid union was obtained 12 weeks on average （from 10 to 16 weeks） after the seeoudary surgery. No flap necrosis, infection, nonunion nr osteomyelitis occurred during the follow-up. Two patienls had tarsnmetatarsal arthrodesis at the 12th or 14th month respective

关 键 词：足损伤 外科手术 骨钉 外固定器 分期治疗 

分 类 号：R687.3[医药卫生—骨科学]