陈旧性跖跗关节骨折脱位治疗分析(附23例报告).docVIP

陈旧性跖跗关节骨折脱位的治疗分析(附23例报告) 　　作者：曲家富　曹立海　杜晓健　王志伟　彭义　高建华　李绍光 作者单位：唐山市第二医院足外科，唐山市足踝外科研究所 河北 063000 　　【摘要】 [目的]探讨陈旧性跖跗关节骨折脱位的手术治疗方法。[方法]2001年9月～2004年12月，手术治疗陈旧性跖跗关节骨折脱位23例，男19例，女4例。年龄18～56岁，平均37.4岁。左侧13例，右侧10例。伤后时间：4～6周7例，6～8周9例，2～3个月4例，5～9个月3例，平均9周。造成陈旧性骨折脱位原因：23例中4例为漏诊， 14例为不恰当的非手术治疗，5例为手术治疗未复位。 按Myerson分类法的X线分型：A型5例，B型4例，C 型2例，D型5例，E型3例，F型4例。术前除了常规拍足部正、侧和30°斜位X线片外，还要行CT扫描，更全面的了解骨折碎片及关节脱位情况。治疗方法：采取切开复位、内固定术 13例，足弓重建跖跗关节融合术 10例。[结果]23例随访8个月～4年，平均2年2个月。治疗结果按Maryland足部评分标准测定：优 4例，良15例 ，可 4例。优良率82.6%。其中采取切开复位内固定术 13例均为优良， 而足弓重建跖跗关节原位融合术 10例：良6例，可 4例。无伤口感染及关节融合不愈合。[结论]早期陈旧性跖跗关节骨折脱位可行切开复位内固定术，疗效满意，而晚期的陈旧性跖跗关节骨折脱位，行足弓重建跖跗关节原位融合术，也可取得较好的治疗效果。 　　【关键词】 陈旧性 跖跗关节 骨折脱位 骨科手术方法 　　Analysis of treatment of oboslete fracture dislocation of tarsometatarsal joints∥ 　　QU Jiafu,CAO Lihai,DU Xiaojian, et al. 　　Institute of Foot and Ankle Surgery of Tangshan, Femur Head Necrosis Therapy Center of Tangshan, Tangshan NO.2 Hospital. Tangshan 063000 ,China 　　Abstract：[Objective]To discuss operative methods to treat oboslete fracture dislocation of tarsometatarsal joints. [Method]From Sep.2001 to Dec.2004, 23 patients (19 males and 4 females) with oboslete fracture dislocation of tarsometatarsal joints were accepted operative therapy(13 patients were left, the others were right). Range of age was from 18 to 56(average 37.4). The postinjury time were 4-6 weeks(7 cases), 6-8 weeks(9 cases),2-3 months(4 cases),5-9 months(3 cases), average 9 weeks. The cause of oboslete were missed diagnosis(4 cases), incorrect non-oper(14 cases), insufficient reposition(5 cases). According to Myerson grouping: 5 A, 4 B, 2 C,5 D,3 E. To observate fracture dislocation allroundly, all patients were examined feet not only with X-ray , but also with computerized tomography,13 patients accepted open reduction and internal fixation, the others accepted instep re-establishment and tarsometatarsal joints fusion.[Result]The follow-up time was from 8 to 48 months ( average 26 months). According to Mary