陈旧性孤立型次趾跖骨头骨折的手术疗效分析  

Chronic isolated fracture of a metatarsal head in lesser toes treated with open reduction and internal fixation

作　　者：李莹[1] 李文菁[1] 龚晓峰[1] 杜辉[1] 武勇[1] Li Ying;Li Wenjing;Gong Xiaofeng;Du Hui;Wu Yong(Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital(The Fourth Medical College,Peking University),Beijing 100035,China)

机构地区：[1]北京积水潭医院(北京大学第四临床医学院)足踝外科,北京100035

出　　处：《中华创伤骨科杂志》2022年第1期33-37,共5页Chinese Journal of Orthopaedic Trauma

基　　金：北京积水潭医院科研基金-青年基金(QN-201910)。

摘　　要：目的探讨陈旧性孤立型次趾跖骨头骨折手术治疗的疗效。方法回顾性分析2018年1月至2021年4月北京积水潭医院足踝外科收治的有症状的陈旧性孤立型次趾跖骨头骨折患者资料。男4例,女1例;受伤时年龄平均为26.2岁(19~36岁)。2例患者初诊时被漏诊。术前主要症状为跖趾关节背伸活动度受限,X线和CT提示远折端向背侧翻转移位。所有患者均行切开复位内固定。比较患者术前及末次随访时的美国足踝外科协会-次趾跖趾关节-趾间关节(AOFAS-LMI)评分、疼痛视觉模拟评分(VAS)、跖趾关节被动背伸活动度,并记录患者术后并发症的发生情况。结果所有患者术后获平均27.8个月(6~45个月)随访。所有骨折均达到骨性愈合。末次随访时AOFAS-LMI评分平均为90.6分(82~100分),VAS疼痛评分中位数为0分(0~2分),跖趾关节被动背伸活动度中位数为40.0°(35°~45°),均较术前[70.6分(59~79分)、4分(2~5分)、10.0°(5.0°~10.0°)]改善。所有患者均能恢复至受伤前的活动水平。3例患者出现跖趾关节关节炎改变。结论切开复位内固定治疗陈旧性孤立型次趾跖骨头骨折疗效满意。Objective To report our clinical outcomes of open reduction and internal fixation(ORIF)of chronic isolated fractures of a metatarsal head in the lesser toes.Methods A retrospective consecutive case-series study was performed in 5 patients with symptomatic chronic isolated shear fracture of a metatarsal head in the lesser toes who had been treated from January 2018 to April 2021 at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital.There were 4 males and one female,with an average age of 26.2 years(from 19 to 36 years)at the time of injury.The fracture had been missed at the initial diagnosis in 2 of the patients.Their main symptom was limited dorsiflexion of the metatarsophalangeal joint(MTPJ).Preoperative X-rays and CT scans revealed dorsal displacement of the distal fragment without dislocation of the MTPJ.All patients were treated by ORIF.Their American Orthopaedic Foot&Ankle Society-lesser metatarsophalangeal-interphalangeal(AOFAS-LMI)score,visual analog scale(VAS),and range of passive dorsiflexion of the MTPJ were compared between preoperation and the final follow-up.Postoperative complications were also recorded.Results The 5 patients were followed up for an average of 27.8 months(from 6 to 45 months).All the chronic fractures achieved bony union.At the final follow-up,the average AOFAS-LMI score was 90.6(from 82 to 100),the average VAS score 0(from 0 to 2),and the average range of passive dorsiflexion of the MTPJ 40.0°(from 35°to 45°),all improved compared with the preoperative values[70.6(from 59 to 79),4(from 2 to 5)and 10.0°(from 5.0°to 10.0°),respectively].All the patients recovered their activity levels before injury.Three patients developed arthritis of the MTPJ.Conclusion ORIF may achieve good short-and mid-term clinical outcomes in patients with chronic isolated shear fracture of a metatarsal head in the lesser toes.

关 键 词：跖骨 关节内骨折 治疗结果 次趾 

分 类 号：R687.3[医药卫生—骨科学]