CAJ | 학술논문

目的探讨跨关节钢板内固定治疗跖跗关节损伤的手术治疗方法和临床疗效. 方法自2009年5月至2011年5月共收治31例跖骨基粉碎性跖跗关节损伤患者,男19例,女12例；年龄24 ～ 70岁,平均46.2岁；均为闭合性损伤,其中8例损伤累及跖跗关节复合体,2例合并骰骨压缩性骨折.所有患者待软组织条件改善后,择期行切开复位跨关节钢板内固定术.术后采用美国足踝外科协会(AOFAS)中足评分、简明健康调查量表(SF-36)评分和视觉模拟评分(VAS)评价治疗效果,并记录相关并发症. 结果 25例患者术后获12 ～36个月(平均24个月)随访,随访期间未见伤口感染、皮瓣坏死等软组织并发症.X线片示术后平均12周(10～15周)骨性愈合.末次随访时AOFAS中足评分为45 ～ 95分(平均78.0分),SF-36评分为45 ～96分(平均79.2分),VAS评分为0～8分(平均1.7分).1例跖跗关节复合体损伤患者术后9个月复查时发现螺钉断裂,但无不适主诉,予以取出内固定；2例跖跗关节复合体损伤患者分别于术后14、20个月发生创伤性关节炎,均予行跖跗关节融合术.结论跨关节钢板内固定治疗跖跗关节损伤技术简单,可避免关节面软骨的再损伤,是治疗跖跗关节损伤安全、有效的方法.
목적 탐토과관절강판내고정치료척부관절손상적수술치료방법화림상료효. 방법 자2009년5월지2011년5월공수치31례척골기분쇄성척부관절손상환자,남19례,녀12례；년령24 ～ 70세,평균46.2세；균위폐합성손상,기중8례손상루급척부관절복합체,2례합병투골압축성골절.소유환자대연조직조건개선후,택기행절개복위과관절강판내고정술.술후채용미국족과외과협회(AOFAS)중족평분、간명건강조사량표(SF-36)평분화시각모의평분(VAS)평개치료효과,병기록상관병발증. 결과 25례환자술후획12 ～36개월(평균24개월)수방,수방기간미견상구감염、피판배사등연조직병발증.X선편시술후평균12주(10～15주)골성유합.말차수방시AOFAS중족평분위45 ～ 95분(평균78.0분),SF-36평분위45 ～96분(평균79.2분),VAS평분위0～8분(평균1.7분).1례척부관절복합체손상환자술후9개월복사시발현라정단렬,단무불괄주소,여이취출내고정；2례척부관절복합체손상환자분별우술후14、20개월발생창상성관절염,균여행척부관절융합술.결론 과관절강판내고정치료척부관절손상기술간단,가피면관절면연골적재손상,시치료척부관절손상안전、유효적방법.
Objective To evaluate clinical outcomes of dorsal spanning plate in treatment of tarsometatarsal joint injury.Methods Between May 2009 and May 2011,31 cases of closed tarsometatarsal joint injury with comminuted fracture of the metatarsal base were treated in our department.They were 19males and 12 females,with an average age of 46.2 years (from 24 to 70 years).The tarsometatarsal joint complex was involved in 8 cases.An open reduction and dorsal spanning plate fixation was performed after the soft tissue situation was ameliorated.Regular X-ray follow-ups were carried out to evaluate overall outcomes using American Orthopaedics Foot and Ankle Society (AOFAS) midfoot score,36-item Short Mos Form Health Survey (SF-36 score) and visual analogue scale (VAS),and complications were also recorded.Results Of all the patients,25 were followed up for an average of 24 months (from 12 to 36 months).There were no such soft tissue complications as wound infection,skin and flap necrosis.X-ray demonstrated bony union at an average of 12 weeks (from 10 to 15 weeks) postoperation.The average AOFAS midfoot score was 78.0 points (from 45 to 95 points),SF-36 score 79.2 points (from 45 to 96 points) and VAS score 1.7 points (from 0 to 8points) at the final follow-up.Screw breakage was found in one patient without complaints at 9 months postoperation and the implant was removed.Obvious pain and limited function caused by post-traumatic arthritis were found at 14 months and 20 months postoperation respectively in 2 patients who had to undergo an arthrodesis eventually.Conclusion Treatment of tarsometatarsal joint injury with dorsal spanning plate is safe and effective,with advantages of operative simplicity and avoidance of iatrogenic damage of articular cartilage.