早期负重小夹板固定法治疗跖趾骨骨折临床观察  

Clinical Observation of Early Weight-bearing Small Splint Fixation in the Treatment of Metatarsophalangeal Fractures

作　　者：吴思团 葛继荣 陈娟 蔡树河 涂丰[5] 黄韵婷 柴昊 郭澜 WU Si-tuan;GE Ji-rong;CHEN Juan;CAI Shu-he;TU Feng;HUANG Yun-ting;CHAI Hao;Guo Lan(College of Traditional Chinese Medicine,Fujian University of Traditional Chinese Medicine,Fuzhuo 350122,Fujian,China;The Hong Kong Bone-setting Specialist and Acupuncturist Clinic,Hong Kong 999077,China;Fujian Academy of Chinese Medical Sciences,Fuzhuo 350003,Fujian,China;Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhuo 350003,Fujian,China;School of Chinese Medicine,Hong Kong Baptist University,Hong Kong 999077,China;Institute of Preventive Treatment of Disease,Beijing University of Traditional Chinese Medicine,Beijing 100029,China)

机构地区：[1]福建中医药大学中医学院,福建福州350122 [2]香港骨伤针灸专科诊所,中国香港999077 [3]福建省中医药科学院,福建福州350003 [4]福建中医药大学附属康复医院,福建福州350003 [5]香港浸会大学中医药学院,中国香港999077 [6]北京中医药大学治未病研究院,北京100029

出　　处：《医学信息》2023年第2期111-115,共5页Journal of Medical Information

摘　　要：目的 观察早期全负重小夹板外固定法治疗跖趾骨骨折的疗效和安全性。方法 回顾性分析2012年6月-2021年9月于香港骨伤针灸专科诊所接受早期全负重小夹板外固定法治疗的跖趾骨骨折13例;以固定前、固定当天、2周、6周、解除固定2周及随访日为顺序,比较固定前后患足全负重行走疼痛VAS评分及步态评分。结果 疼痛VAS评分的时间效应有统计学意义(F=118.803,P<0.001),随访日VAS评分低于固定前、固定当天、2周、6周和解除固定2周步态评分比较,差异有统计学意义(χ2=53.359,P<0.001);采用Bonferroni法校正显著性水平的事后两两比较发现,固定前步态评分高于固定后2周、6周、解除2周和随访日(调整后P=0.030、P=0.002、P<0.001和P<0.001);固定当天步态评分高于固定6周、解除2周和随访日(调整后P=0.042、P=0.002和P<0.001)。临床愈合与功能恢复基本同步;治愈率100.00%,愈合时间6(4,8)周。未见并发症或后遗症。结论 早期全负重小夹板外固定法治疗跖趾骨骨折,于固定当天即可较为显著减轻行走疼痛、改善痛性跛行步态,近期及远期疗效均满意。Objective To observe the efficacy and safety of early total weight-bearing small splint external fixation in the treatment of metatarsophalangeal fractures.Methods A total of 13 cases of metatarsophalangeal fractures treated with early total weight-bearing small splint external fixation in The Hong Kong Bone-setting Specialist and Acupuncturist Clinic from June 2012 to September 2021 were analyzed retrospectively. In the order of before fixation, on the day of fixation, 2 weeks, 6 weeks, 2 weeks after loosening fixation and follow-up day,the pain VAS score and gait score of injured foot weight-bearing walking before and after fixation were compared. Results The time effect of pain VAS score was statistically significant(F =118.803, P <0.001). The VAS score on the follow-up day was lower than that before fixation, on the same day of fixation, 2 weeks, 6 weeks and 2 weeks of release fixation, the difference was statistically significant( χ2=53.359, P <0.001). After the Bonferroni method was used to correct the significance level, it was found that the gait score before fixation was higher than that after fixation for 2 weeks, 6weeks, release for 2 weeks and follow-up day(after adjusted P=0.030, P=0.002, P<0.001 and P<0.001);the gait score on the same day of fixation was higher than that on the day of fixation for 6 weeks, release for 2 weeks and follow-up day(after adjusted P=0.042, P=0.002 and P<0.001). Clinical healing and functional recovery were basically synchronized. The cure rate was 100.00%, the average healing time was 6(4,8)weeks. There were no complications or sequelae.Conclusion Early total weight-bearing small splint external fixation in the treatment of metatarsophalangeal fractures can significantly reduce walking pain and improve painful claudication gait on the same day of fixation. the short-term and long-term effects are satisfactory.

关 键 词：第5跖骨基底部骨折 跖骨颈骨折 趾骨骨折 足形小夹板 小夹板固定 早期负重 

分 类 号：R683.42[医药卫生—骨科学]