内侧入路微型锁定接骨板治疗第一跖骨干粉碎性骨折  

TREATMENT OF FIRST METATARSAL DIAPHYSIS COMMINUTED FRACTURES WITH MINI-PLATE VIA MEDIAL APPROACH

作　　者：李兵[1] 杨云峰[1] 陈凯[1] 于涛[1] 任昊旸 陈大伟[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中国修复重建外科杂志》2015年第2期138-140,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81372011)~~

摘　　要：目的探讨通过内侧入路微型锁定接骨板治疗第1跖骨干粉碎性骨折的疗效。方法 2012年1月-2013年1月,经内侧入路微型锁定接骨板治疗15例第1跖骨干粉碎性骨折。男11例,女4例;年龄27-56岁,平均38.6岁。致伤原因：摔伤6例,重物砸伤7例,扭伤2例。左足6例,右足9例。受伤至手术时间7-10 d,平均8.5 d。骨折根据AO分型均为81（T）-C2型。结果术后切口均Ⅰ期愈合,无感染等并发症发生。12例患者获随访,随访时间12-24个月,平均18个月。X线片复查示骨折均愈合,愈合时间10-14周,平均11.5周;随访期间无内固定物松动、断裂发生。末次随访时,患者均可完全负重行走,无明显疼痛不适。参照美国矫形足踝协会（AOFAS）的趾（第1跖骨、趾骨）评分标准为76-96分,平均85.2分。结论经内侧入路微型锁定接骨板固定是治疗第1跖骨干粉碎性骨折的一种有效方法,且内侧入路更安全,足部外观满意。Objective To explore the effectiveness and operative methods to treat first metatarsal diaphysis comminuted fractures with mini-plate via medial approach. Methods Between January 2012 and January 2013, 15 patients with first metatarsal shaft comminuted fractures were treated. There were 11 males and 4 females（6 left feet and 9 right feet） with an average age of 38.6 years（range, 27-56 years）. The injury causes included falling injury in 6 cases, crash injury of heavy object in 7 cases, and sprain in 2 cases. The left side was involved in 6 cases and the right side in 9 cases. The time from injury to operation was 8.5 days on average（range, 7-10 days）. According to AO classification, all cases were rated as 81（T）-C2 type. The surgical treatments included open reduction and internal fixation with mini-plate by medial approach. Results Primary healing of incision was obtained in all cases, and no infection occurred. Twelve patients were followed up 18 months on average（range, 12-24 months）. All fractures healed well, and the mean time of bone union was 11.5 weeks（range, 10-14 weeks）. No loosening or breakage of internal fixation was observed. At last follow-up, the patients could walk with full weight-bearing, and had no pain. According to American Orthopaedic Foot and Ankle Society（AOFAS） hallux metatarsophalangeal-interphalangeal scale, the mean score was 85.2（range, 76-96）. Conclusion Anatomic reduction and stable internal fixation are important for first metatarsal comminuted fracture, which is the key point for recovery of foot form and foot arch function. And the medial approach could achieve full exposure and improve the cosmetic results.

关 键 词：第1跖骨干粉碎性骨折 手术入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]