腓骨长肌腱撕脱致第1跖骨基底部骨折跨跖楔关节接骨板固定的疗效  

Efficacy of tarsometatarsal plate fixation for first metatarsal base fractures caused by peroneus longus tendon avulsion

作　　者：王之枫 耿翔 王晨 张超 王旭 马昕 WANG Zhifeng;GENG Xiang;WANG Chen;ZHANG Chao;WANG Xu;MA Xin(Department of Orthopaedics,Huashan Hospital Affiliated with Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨与关节外科杂志》2024年第8期693-698,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(81772416)。

摘　　要：目的:评价跨跖楔关节接骨板固定治疗腓骨长肌腱撕脱致第1跖骨基底部骨折的疗效。方法:回顾性分析2015年1月至2020年12月于复旦大学附属华山医院接受手术治疗的9例腓骨长肌腱撕脱致第1跖骨基底部骨折患者的临床资料。其中男7例,女2例,年龄31~64岁,平均(45.0±13.1)岁,左足8例,右足1例。分析该组患者骨折的影像学特点。所有患者均行切开复位内固定术,骨折解剖复位后应用跨跖楔关节接骨板固定。随访记录患者疼痛视觉模拟评分(VAS)、美国骨科足踝外科协会(AOFAS)中足评分,并根据X线表现评估第1跖楔关节有无退行性变,同时记录并发症发生情况。结果:9例患者术后平均(14.4±3.1)个月(11~19个月)取出内固定物,未见接骨板或螺钉断裂。随访29~53个月,平均随访(42.6±10.2)个月。末次随访时所有患者影像学评估未见第1跖楔关节退行性变表现;VAS评分0~1分,平均(0.3±0.1)分;AOFAS中足评分90~97分,平均(93.0±2.5)分。所有患者均未出现内固定物松动及断裂。1例患者出现切口浅表感染,经清创换药后切口愈合。结论:腓骨长肌腱撕脱致第1跖骨基底部骨折较少见。解剖复位并跨跖楔关节接骨板固定能恢复第1跖列与腓骨长肌腱的解剖结构,重建内侧柱稳定性,可取得良好的临床疗效。Objective:To analyze the characteristics of first metatarsal base fractures caused by peroneus longus tendon avulsion,and to evaluate the short-and medium-term efficacy of the tarsometatarsal plate fixation.Methods:The study included 9 patients with first metatarsal base fractures caused by peroneus longus tendon avulsion who underwent surgery at Huashan Hospital affiliated with Fudan University from January 2015 to December 2020.The cohort comprised 7 males and 2 females,with 8 left feet and 1 right foot.Radiographic analysis was performed to characterize the fractures.All patients underwent open reduction and internal fixation.After anatomical reduction,the fracture was fixed with the tarsometatarsal plate.The visual analogue scale(VAS)score and American Orthopedic Foot and Ankle Society(AOFAS)midfoot score were recorded during the follow-up.Degeneration of the first tarsometatarsal joint was evaluated according to X-ray findings,and any complications were recorded.Results:The internal fixation was removed in 9 patients at an average of 14.4±3.1 months(range,11-19 months)postoperatively,with no rupture of bone plate or screw.The average follow-up duration was 42.6±10.2 months(range,29-53 months).At the final follow-up,no signs of degenerative changes were observed in the first tarsometatarsal joint on imaging.The VAS score ranged from 0 to 1 points,with an average of 0.3±0.1 points.The AOFAS midfoot score ranged from 90 to 97 points,with an average of 93.0±2.5 points.Conclusions:First metatarsal base fractures caused by peroneus longus tendon avulsion are relatively rare.Treatment with anatomical reduction and tarsometatarsal plate fixation achieved good short-and medium-term clinical and imaging outcomes,which could restore the biomechanical integrity of the first metatarsal and peroneus longus tendons and reconstruct the stability of the medial column.

关 键 词：第1跖骨基底部骨折 腓骨长肌腱撕脱 跖楔关节 接骨板 

分 类 号：R683.4[医药卫生—骨科学]