CAJ | 학술논문

目的回顾复杂中足损伤的临床治疗,评价其临床治疗的特点及要点.方法 2003年6月至2008年6月问收治22例复杂中足损伤患者,其中开放性骨折8例,伴有软组织缺损者5例.急诊收治患者13例,另9例为外院已处理的患者.急诊患者中仅1例行舟骨和中间、外侧楔骨的关节融合,其余均行复位和内固定.转诊患者:2例行距舟关节融合,3例行Lisfranc关节融合伴1例行趾近节截除,1例行舟楔火节融合,1例行跗横火节融合,1例行内侧柱截除,1例行外侧柱重建.5例伴软组织缺损的患者,4例行游离前锯肌移植,1例行腓肠神绛伴行血管逆行岛状皮瓣移植修复.结果全部患者术后随访5～44个月,平均17.5个月.急诊患者随访时的主要后遗症状为长时问行走后疼痛,2例患者经应用局部封闭及非甾体类镇痛药治疗后症状缓解.转诊患者中,2例行走时易疲劳、酸痛;2例外侧第4、5跖骨头跖侧胼胝伴疼痛;1例前、中、后足僵硬,同时存在足内肌较广泛的萎缩,有较重的行走疼痛;内侧柱截除的患者有足弓塌陷、后足外翻的表现,使用特制鞋行走.急诊收治患者AOFAS评分为(80.3±8.7)分,转诊患者为(60.1±16.3)分.结论复杂的中足损伤应在允分了解功能解剖、创伤病理的基础上早期手术,解剖复位和牢靠同定是获得良好疗效的关键.
목적 회고복잡중족손상적림상치료,평개기림상치료적특점급요점.방법 2003년6월지2008년6월문수치22례복잡중족손상환자,기중개방성골절8례,반유연조직결손자5례.급진수치환자13례,령9례위외원이처리적환자.급진환자중부1례행주골화중간、외측설골적관절융합,기여균행복위화내고정.전진환자:2례행거주관절융합,3례행Lisfranc관절융합반1례행지근절절제,1례행주설화절융합,1례행부횡화절융합,1례행내측주절제,1례행외측주중건.5례반연조직결손적환자,4례행유리전거기이식,1례행비장신강반행혈관역행도상피판이식수복.결과 전부환자술후수방5～44개월,평균17.5개월.급진환자수방시적주요후유증상위장시문행주후동통,2례환자경응용국부봉폐급비치체류진통약치료후증상완해.전진환자중,2례행주시역피로、산통;2예외측제4、5척골두척측변지반동통;1례전、중、후족강경,동시존재족내기교엄범적위축,유교중적행주동통;내측주절제적환자유족궁탑함、후족외번적표현,사용특제혜행주.급진수치환자AOFAS평분위(80.3±8.7)분,전진환자위(60.1±16.3)분.결론 복잡적중족손상응재윤분료해공능해부、창상병리적기출상조기수술,해부복위화뢰고동정시획득량호료효적관건.
Objective To evaluate the features and key points of clinical treatment of the complex midfoot injury retrospectively.Methods Twenty-two cases of complex midfoot injury were admitted to our hospital from June 2003 to June 2008, including 8 cases of open fracture and 5 cases of complicated soft tissue defects.Thirteen were emergency cases and the other 9 chronic ones were referred from other hospitals.In the emergency cases, only 1 underwent arthrodesis of the navicular and middle and lateral cuneiform and the others had reduction and internal fixation.In the referred cases, 2 received talar-navicular arthrodesis, 3 Lisfranc arthrndesis (accompanied by distal hallux amputation in 1), 1 navicular-cuneiform arthrudesis and 1 Chopart arthrndesis, 1 medial column amputation and 1 lateral column reconstruction.In the cases of soft tissue defects, 4 underwent free serratus anterior transfer, and 1 had transfer of distally-based sural fas-eio-cutaneous flap.The American Orthopaedic Foot & Ankle Society (AOFAS) scoring was used to evaluate the results.Results All the patients were followed up for 5 to 44 (average, 17.5) months.The main sequelae of the emergency cases were pain after long time waking, which was relieved following local injection of steroid and NIADs in 2 cases.Of the referred cases, pain and fatigue after walking were reported in 2, callus and pain under the 4th and 5th metatarsal heads in 2, and the whole foot rigidity and atrophy of the intrinsic muscle with severe pain while walking in 1.The case of medial column amputation developed medial arch collapse and valgus of hind foot.The mean AOFAS score for the emergency cases was 80.3± 8.7 and for the chronic ones was 60.1±16.3.Conclusion For complex midfoot injury, good results can only be obtained by early operation, anatomic reduction and stable fixation on the basis of enough understanding of the functional anatomy and traumatic pathology.