跗跖关节脱位的影像学分型及术后影像学评价  

Radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation

作　　者：董倩[1] 范娇娇[2] 王金枝 张平[2] 李晓娜[2] 陈伟[3] 张泽坤[2] 

机构地区：[1]河北医科大学第三医院放射科,河北石家庄050051 [2]河北医科大学第三医院CT室,河北石家庄050051 [3]河北医科大学第三医院创伤急救骨科,河北石家庄050051

出　　处：《实用放射学杂志》2017年第12期1913-1916,共4页Journal of Practical Radiology

摘　　要：目的 分析跗跖关节脱位的影像分型及脱位术后的影像学评价。方法 跗跖关节脱位患者74例，按照Myerson分型进行分析，根据美国骨科矫形足踝协会（AOFAS）足评分标准对患者进行评分。结果 Myerson A型脱位19例，Myerson B型脱位46例，Myerson C型脱位9例，远排跗骨骨折39处，跖骨骨折156处，合并舟骨骨折10例，术后均获得随访，无感染，AOFAS评分中优22例、良29例、可17例、差6例。术后影像学评价要求跗跖关节解剖复位，即：足正位第2跖骨基底内缘和中间楔骨内缘连续成1条直线，第1、2跖骨基底最短距离＜2 mm；足内斜位第4跖骨基底内缘和骰骨内缘为完整光滑连线；足侧位第2跖骨背侧缘和中间楔骨背缘为光滑连线，跖骨不应超过相对应楔骨背侧，足弓角恢复正常。结论 跗跖关节脱位以B型为常见，常合并多骨骨折，术中、术后应多体位观察跗跖关节解剖学复位情况，以减少创伤性关节炎的发生。Objective To study radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation .Methods 74 patients with tarsometatarsal joint dislocation were included in this study.Tarsometatarsal joint dislocations were classified by the Myerson fracture displacements classification. All patients were evaluated according to the American Orthopedics Foot ＆ Ankle Society （AOFAS） clinical rating systems. Results There were 19 patients with Myerson A, 46 patients with Myerson B and 9 patients with Myerson C tarsometatarsal joint dislocation. 39 distal tarsal bone fractures and 156 metatarsal fractures, with simultaneous scaphoid fractures in 10 patients were showed.All patients who were followed up and no infection.The AOFAS scale was categorized as excellent,good,fair or poor, and 2 2 patients were considered as excellent, 29 patients as good, 17 patients as fair and 6 patients as poor. Postoperative imaging evaluation required anatomical reduction of tarsometatarsal joint. On the anteroanterior radiogragh, the base medial edge of the second metatarsal bone and the medial edge of intermediate cuneiform were combined to form a straight line.The shortest distance between the base of the first metatarsal bone and the second metatarsal bone should be less than 2 mm. On the medial oblique radiogragh,a smooth line connecting the medial edge of the fourth metatarsal bone with the medial edge of cuboid bone always appeared. On the lateral radiogragh, the dorsal edge of the second metatarsal bone and intermediate cuneiform formed a smooth line. The height of metatarsus should not exceed the dorsal edge of corresponding cuneiform. The longitudinal arch angle was restored within normal limits. Conclusion The type-B tarsometatarsal joint dislocation is the most common type and frequently accompanies by multiple fractures. Intraoperative and postoperative multidirectional observation of anatomical reduction of tarsometatarsal joint dislocation can reduce incidence of posttraumatic arthritis.

关 键 词：跗跖关节 脱位 骨折 手术治疗 术后评价 

分 类 号：R681.8[医药卫生—骨科学] R683[医药卫生—外科学]