跖跗关节损伤治疗方法的疗效分析  

The clinical results of different treatment of tarsometatarsal joint injuries

作　　者：陈东[1] 夏天[1] 杨述华[1] 叶树楠[1] 陈超[1] 许伟华[1] 华文彬[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022

出　　处：《临床骨科杂志》2012年第5期556-558,共3页Journal of Clinical Orthopaedics

基　　金：中央高校基本科研业务费专项基金(编号:2010JC029;2011JC042);国家自然科学基金(编号:81171750;30973044)

摘　　要：目的探讨不同方式治疗跖跗关节损伤的临床疗效。方法对35例单足跖跗关节损伤患者根据骨折分型应用石膏固定2例,闭合复位经皮内固定12例,开放复位内固定20例,二期关节融合术1例。结果 35例均获随访,时间3～9(5±2)个月。克氏针松动8例,螺钉断钉2例,创伤后关节炎8例。临床评估依据美国矫形足踝协会(AOFAS)中足评分标准:优12例,良17例,可5例,差1例。结论解剖复位、牢靠固定是治疗跖跗关节损伤的基本原则。中间柱复位并沿Lisfranc韧带方向固定内侧楔骨和第2跖骨基底部是重建跖跗关节复合体稳定性的关键,依据跖跗关节的"三柱"原理选择固定方式,可获得满意疗效。Objective To investigate the clinical results of different treatments of tarsometatarsal joint injuries. Methods 35 patients with unilateral foot were treated in our hospital. 2 eases were treated with east immobilization, 12 cases were treated with close reduction and internal fixation, 20 cases were treated with open reduction and internal fixation, one case was treated with secondary stage arthrodesis. Results All eases were followed up from 3 months to 9 months （average 5 ±2 months）. Complications were looseness of K-wires in 8 cases, screw breakage in 2 eases and traumatic arthritis in 8 eases. There were excellent in 12 patients, good in 17 patients, fair in 5 patients and poor in 1 patient according to the American Orthopaedic Foot and Ankle Society （AOFAS） midfoot score. Conclusions Anatomical reduction and stable fixation of Lisfranc injuries is the principle that leads to the best outcomes. Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to restablishment of the tarsometatarsal joint complex. According to the principle of the ＂Three Pillars＂ of the tarsometatarsal joint,the method of fixation is choosed.

关 键 词：LISFRANC损伤 跖跗关节损伤 关节融合术 骨折固定术 

分 类 号：R684.77[医药卫生—骨科学] R687.4[医药卫生—外科学]