镍钛形状记忆弓齿钉治疗多发跖骨骨折的临床疗效  

Application of nickel-titanium shape memory staples in treatment of multiple metatarsal fractures

作　　者：陈杰 殷榛 周维波 谭文 周福临 CHEN Jie;YIN Zhen;ZHOU Weibo;TAN Wen;ZHOU Fulin(Department of Orthopedics,the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou Jiangsu,213100,P.R.China)

机构地区：[1]南京医科大学附属常州第二人民医院骨科,江苏常州213100

出　　处：《中国修复重建外科杂志》2025年第2期146-150,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨运用镍钛形状记忆弓齿钉治疗多发跖骨骨折的临床疗效。方法回顾性分析2022年1月—2023年6月收治且符合选择标准的27例多发跖骨骨折患者临床资料。男16例,女11例;年龄33~65岁,平均47.44岁。致伤原因:重物砸伤11例,交通事故伤9例,挤压伤7例。合并2根跖骨骨折6例,3根骨折6例,4根骨折4例,5根骨折8例;合并跖跗关节损伤3例。弓齿钉固定部位:跖骨颈部骨折16根、干部骨折22根、基底部骨折9根、跗跖关节损伤5根。术前存在软组织损伤表现8例,Tscherne-Oestern闭合型软组织损伤分型Ⅰ型5例、Ⅱ型3例,Ⅱ型中1例术前已出现皮肤坏死。采用镍钛形状记忆弓齿钉固定治疗。记录并发症及骨折愈合情况;末次随访时,采用美国矫形足踝协会(AOFAS)中前足评分评价功能,疼痛视觉模拟评分(VAS)评估疼痛情况。结果27例患者均获随访,随访时间9~19个月,平均12.4个月。术后复查X线片示未出现骨折复位丢失,均获骨性愈合,无内固定物松动、断裂等失效情况发生;骨折愈合时间3~4个月,平均3.13个月。术后4例(Tscherne-OesternⅠ型2例、Ⅱ型2例)出现浅表皮肤坏死,经换药治疗后愈合;其余患者均未发生感染,创面愈合。末次随访时,患者AOFAS中前足评分为70~95分,平均86.6分,其中优19例、良6例、中2例,优良率92.6%;VAS评分为0~3分,平均0.9分,其中优24例、良3例,优良率100%。结论运用镍钛形状记忆弓齿钉治疗多发跖骨骨折,可在有效内固定的同时较好保护局部皮肤软组织,减少因内固定物植入带来的二次损伤,是一种可供选择的手术方式。Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures.Methods The clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed.The cohort consisted of 16 males and 11 females,aged 33-65 years(mean,47.44 years).The causes of injury included heavy object impact in 11 cases,traffic accidents in 9 cases,and crush in 7 cases.Simultaneous fractures of 2,3,4,and 5 bones occurred in 6,6,4,and 8 cases,respectively,with tarsometatarsal joint injury in 3 cases.Fixation was performed using staples for 16,22,and 9 fractures in the metatarsal neck,shaft,and the base,respectively,and 5 tarsometatarsal joint injuries.Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases.One case of typeⅡexhibited preoperative skin necrosis.The patients were treated with fixation using nickel-titanium shape memory staples.Complications and fracture healing were documented.At last follow-up,the American Orthopaedic Foot and Ankle Society(AOFAS)forefoot score was used to evaluate the function,and the visual analogue scale(VAS)score was used to evaluate the pain.Results The 27 patients were followed up 9-19 months(mean,12.4 months).Postoperative X-ray films revealed no loss of fracture reduction,and all fractures achieved bony union.No internal fixator loosening,breakage,or other mechanical failures was observed.The mean fracture healing time was 3.13 months(range,3-4 months).Postoperatively,4 cases(2 of Tscherne-Oestern typeⅠ,2 of typeⅡ)developed superficial skin necrosis,which resolved with dressing changes.No infection was observed in the remaining patients,and all wounds healed.At last follow-up,the AOFAS forefoot score ranged from 70 to 95,with an average of 86.6,of which 19 cases were excellent,6 cases were good,

关 键 词：多发跖骨骨折 镍钛记忆合金 内固定 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]