静态骑缝钉固定治疗外侧跖骨颈骨折的临床疗效  

The clinical effect of static staple in the treatment of lateral metatarsal neck fracture

作　　者：李建鹏 王松[2] 高翔 胡永成[3] Li Jianpeng;Wang Song;Gao Xiang;Hu Yongcheng(Tianjin Medical University,Graduate School,Tianjin 300070,China;Department of Orthopaedic Surgery,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Bone and Soft Tissue Oncology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医科大学研究生院,300070 [2]天津市第五中心医院骨科,300450 [3]天津市天津医院骨与软组织肿瘤科,300211

出　　处：《中华外科杂志》2020年第9期713-717,共5页Chinese Journal of Surgery

基　　金：天津市滨海新区卫生计生委科技项目(2015BWKZ004、2017BWKY036)。

摘　　要：目的探讨静态骑缝钉治疗跖骨颈骨折的临床疗效。方法回顾性分析天津市第五中心医院骨科2017年1月至2018年12月收治的34例第2~5跖骨颈骨折患者的临床资料。17例患者采用静态骑缝钉治疗,17例采用逆行克氏针治疗。静态骑缝钉组:男性11例,女性6例,年龄34.6岁(范围:21~50岁),右侧10例,左侧7例。逆行克氏针组:男性12例,女性5例,年龄36.2岁(范围:23~53岁),右侧9例,左侧8例。采用美国足踝外科协会(AOFAS)中前足评分、疼痛视觉模拟评分(VAS)、测量患侧跖趾关节的主动屈伸活动范围,比较两组临床疗效,并记录骨折愈合时间,统计术后并发症情况。采取独立样本t检验、非参数检验或χ^2检验对组间各指标进行比较。结果患者均获得随访,随访时间14.2个月(范围:12~17个月)。所有患者骨折均愈合,静态骑缝钉组和逆行克氏针组患者的骨折愈合时间无差异[(11.2±2.1)周比(11.5±3.1)周,t=0.030,P=0.743]。末次随访时,静态骑缝钉组和逆行克氏针组的VAS[1.00(1.00)分比1.00(1.50)分M(QR),Z=-0.443,P=0.658]和AOFAS中前足评分[(90.9±5.3)分比(88.6±6.1)分,t=1.174,P=0.249]的差异无统计学意义;而患侧跖趾关节主动背伸活动范围[(35.1±4.3)°比(31.2±6.4)°,t=2.055,P=0.048]及屈曲活动范围[(34.7±4.5)°比(30.2±5.3)°,t=2.681,P=0.011]的差异均有统计学意义。静态骑缝钉组1例开放性骨折患者出现局部皮肤坏死,3例患者负重行走后出现跖痛症。逆行克氏针组4例负重行走后出现跖痛症,2例出现轻度背伸挛缩及关节疼痛。无伤口感染、内固定松动断裂等并发症。结论静态骑缝钉治疗第2~5跖骨颈骨折,手术微创,固定牢靠,有效减少肌腱、关节粘连等并发症,利于骨折愈合及关节功能恢复,疗效满意。Objective To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture.Methods The clinical data of 34 patients with the 2nd to 5th metatarsal neck fracture admitted to the Department of Orthopaedic Surgery,Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group,there were 11 males,6 females,aged 34.6 years(range:21 to 50 years),10 cases on the right side,7 cases on the left side.In retrograde Kirschner wire group,there were 12 males and 5 females,aged 36.2 years(range:23 to 53 years),9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score(AOFAS)forefoot score,visual analogue scale(VAS),and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test,non-parametric orχ^2 test.Results All patients were followed up for 14.2 months(range:12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time((11.2±2.1)week vs.(11.5±3.1)week,t=0.030,P=0.743).There was no statistically significant difference between VAS(1.00(1.00)vs.1.00(1.50)M(QR),Z=-0.443,P=0.658)and AOFAS scores(90.9±5.3 vs.88.6±6.1,t=1.174,P=0.249)at the last follow-up.The difference in active dorsiflexion((35.1±4.3)°vs.(31.2±6.4)°,t=2.055,P=0.048)and flexion range of motion((34.7±4.5)°vs.(30.2±5.3)°,t=2.681,P=0.011)between the two groups was statistically significant.One case of open fracture in the Solustaple group had local skin necrosis,and three patients had metatarsal pain after weight-bearing walking.Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking,and two

关 键 词：跖骨 骨折 内固定器 

分 类 号：R687.3[医药卫生—骨科学]