跖内侧入路跖侧钢板治疗第一跖骨基底部骨折的疗效分析  

Surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach

作　　者：肖伟元 董宇启[1] 张超[1] Xiao Weiyuan;Dong Yuqi;Zhang Chao(Department of Trauma Orthopaedics,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院创伤骨科,200127

出　　处：《中华创伤骨科杂志》2021年第7期631-635,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨跖内侧入路跖侧钢板治疗第1跖骨基底部骨折的疗效。方法回顾性研究2016年1月至2018年12月上海交通大学医学院附属仁济医院创伤骨科收治的12例第1跖骨基底部骨折患者资料。其中男8例,女4例;年龄平均39.6岁(27~54岁);左足5例,右足7例。术中应用跖内侧入路跖侧钢板固定第1跖骨基底部骨折及跖跗关节不稳,若合并其他跖跗关节损伤则同时行背侧切口复位固定。术后定期摄X线片,并记录末次随访时的美国足踝外科协会(AOFAS)的中足评分、疼痛视觉模拟评分(VAS)及并发症的发生情况。结果所有患者术后获12~19个月(平均15.1个月)随访。12例患者伤口均一期愈合,无皮肤坏死、感染、神经血管损伤等并发症发生。所有患者骨折均愈合,愈合时间12~14周(平均12.6周)。末次随访时所有患者均可完全负重行走,踝关节跖屈、背伸及内外翻肌力正常,X线片示跖跗关节复位无丢失。末次随访时AOFAS的中足评分为82~96分(平均88.9分),VAS评分为0~3分(平均1.2分)。结论跖内侧入路跖侧钢板治疗主要骨折块位于跖侧的第1跖骨基底部骨折可以获得满意的疗效。Objective To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics,Renji Hospital.They were 8 men and 4 women,with an average age of 39.6 years(from 27 to 54 years).The fracture affected the left foot in 5 cases and the right foot in 7.Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach,and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined.Postoperative X-ray follow-ups were performed regularly.The American Orthopedic Foot and Ankle Society(AOFAS)midfoot scores,visual analogue scale(VAS)pain scores and complications were recorded at the final follow-up.Results All the patients were followed up for 12 to 19 months(mean,15.1 months).Primary incision healing was observed in all the 12 patients.No complications like skin necrosis,infection or neurovascular lesion occurred.Fracture union was achieved in all the 12 patients after 12 to 14 weeks(average,12.6 weeks).At the final follow-up,all the patients could walk with full weight-bearing,the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal,and the X-ray film showed that reduction of the tarsometatarsal joint was not lost.At the final follow-up,the AOFAS midoot scores ranged from 82 to 96(mean,88.9)and the VAS scores from 0 to 3(mean,1.2).Conclusion Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base,especially for those with a major fracture fragment at the metatarsal planter side.

关 键 词：骨折固定术 内 内固定器 跖骨 骨板 LISFRANC损伤 

分 类 号：R687.3[医药卫生—骨科学]