分期与择期手术治疗急性闭合性跖跗关节复合体骨折脱位的疗效比较  

Comparison of efficacy of staged versus elective operation for treating acute closed fracture‑dislocation of tarsometatarsal joint complex

作　　者：李兵[1] 和文宝 夏江[1] 赵有光[1] 周海超[1] 杨云峰[1] 俞光荣[1] Li Bing;He Wenbao;Xia Jiang;Zhao Youguang;Zhou Haichao;Yang Yunfeng;Yu Guangrong(Department of Orthopedics,Tongji Hospital,Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中华创伤杂志》2023年第6期508-513,共6页Chinese Journal of Trauma

摘　　要：目的比较分期与择期手术治疗急性闭合性跖跗关节复合体骨折脱位的疗效。方法采用回顾性队列研究分析2017年1月至2021年1月同济大学附属同济医院收治的26例急性闭合性跖跗关节复合体骨折脱位患者的临床资料,其中男18例,女8例;年龄32~52岁[(44.3±5.2)岁]。按照受伤至收治时间分组,伤后8 h内收治的14例患者行分期手术治疗(分期组),Ⅰ期手术均为急诊在C形臂X线机监视下行复位和克氏针临时内固定术,待肿胀消退后Ⅱ期行跖跗关节骨折脱位的切开复位内固定术;伤后超过8 h收治的12例患者行择期手术(择期组),待肿胀消退后,择期行跖跗关节骨折脱位的切开复位内固定术。比较两组手术时间、住院时间和骨折愈合时间;术前、术后1,6,12个月及末次随访时视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)中足评分;术后并发症发生率。结果患者均获随访12~24个月[(18.5±3.8)个月]。分期组手术时间、住院时间和骨折愈合时间分别为(77.3±5.6)min、(14.3±2.2)d、(12.3±1.2)周,短于择期组的(101.5±7.5)min、(20.3±5.2)d、(14.3±2.2)周(P均<0.01)。随着术后时间延长,两组VAS显著降低,AOFAS中足评分显著升高(P均<0.05)。两组术前、术后12个月及末次随访时VAS差异无统计学意义(P均>0.05);分期组术后1,6个月VAS分别为(4.4±0.8)分、(2.1±0.4)分,低于择期组的(6.0±1.0)分、(3.5±0.6)分(P均<0.01)。两组术前AOFAS中足评分差异无统计学意义(P>0.05);分期组术后1,6,12个月及末次随访时AOFAS中足评分分别为(67.6±4.5)分、(75.7±5.2)分、(83.6±2.2)分、(85.9±4.3)分,高于择期组的(60.2±3.9)分、(70.2±3.4)分、(75.4±3.3)分、(78.7±4.4)分(P均<0.01)。分期组并发症发生率为14.3%(2/14),低于择期组的33.3%(4/12)(P<0.05)。结论与传统择期手术相比,分期手术治疗急性闭合性跖跗关节复合体骨折脱位可缩短手术时间、住院时间和骨折愈合时间,较快减轻Objective To compare the efficacy of staged versus elective operation for treating acute closed fracture‑dislocation of tarsometatarsal joint complex.Methods A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture‑dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021,of whom 18 were males and 8 were females,aged 32‑52 years[(44.3±5.2)years].According to the time from injury to admission,14 patients admitted within 8 hours after injury underwent staged surgical treatment(staged group),and 12 patients admitted more than 8 hours after injury underwent elective surgery(elective group).In the staged group,emergency reduction and temporary internal fixation with K‑wire were done under the supervision of a C‑arm X‑ray machine in the first stage,while after the swelling subsided,open reduction and internal fixation were done for tarsometatarsal joint fracture‑dislocation in the second stage.In the elective group,open reduction and internal fixation were performed for tarsometatarsal joint fracture‑dislocation on a scheduled basis after the swelling subsided.The operation time,hospitalization time and fracture healing time were recorded.The visual analogue score(VAS)and American Orthopedic Foot and Ankle Society(AOFAS)midfoot score were evaluated before operation,at 1,6,12 months after operation and at the final follow‑up.The rate of complications was observed after operation.Results All patients were followed up for 12‑24 months[(18.5±3.8)months].The operation time,hospitalization time and fracture healing time in the staged group were(77.3±5.6)minutes,(14.3±2.2)days and(12.3±1.2)weeks,respectively,significantly shorter than those in the elective group[(101.5±7.5)minutes,(20.3±5.2)days and(14.3±2.2)weeks](all P<0.01).VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased(all P<0.05).There were no signi

关 键 词：跖骨 跗关节 关节脱位 骨折固定术 内 

分 类 号：R687.4[医药卫生—骨科学]