CAJ | 학술논문

目的提出中足损伤畸形愈合的分型,并探讨中足损伤畸形愈合的临床治疗特点及要点. 方法回顾性分析自2004年6月至2012年6月收治且获得随访的22例中足损伤畸形愈合患者资料,男19例,女3例;年龄16 ～ 65岁,平均37.8岁.其中单纯Lisfranc关节骨折脱位6例,严重Lisfranc关节复合体损伤伴骰骨压缩骨折7例,严重Lisfranc关节复合体损伤合并舟骨骨折9例.足背部软组织条件较差,有大面积瘢痕者8例.根据自己提出的分型进行分型:Ⅰa型2例,Ⅰc型4例;Ⅱa型9例;Ⅲa型4例,Ⅲc型3例.根据畸形形态选用皮瓣移植、截骨矫形关节融合纠正畸形,恢复力线.术后通过临床检查及X线片进行随访,临床评估采用疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)中足评分. 结果所有患者术后获15 ～53个月(平均34.7个月)随访.末次随访时患者的VAS评分为0～6分,平均2.0分;AOFAS中足评分为73 ～ 94分,平均83.9分,优良率为81.8％.1例患者术后3年行走时仍存在中足疼痛,其余患者恢复良好,融合术后无骨不连发生.结论自己提出的分型有助于中足损伤畸形愈合的手术治疗,可获得满意疗效.稳定受伤关节,恢复足部力线和足弓是获得良好疗效的关键.
목적 제출중족손상기형유합적분형,병탐토중족손상기형유합적림상치료특점급요점. 방법 회고성분석자2004년6월지2012년6월수치차획득수방적22례중족손상기형유합환자자료,남19례,녀3례;년령16 ～ 65세,평균37.8세.기중단순Lisfranc관절골절탈위6례,엄중Lisfranc관절복합체손상반투골압축골절7례,엄중Lisfranc관절복합체손상합병주골골절9례.족배부연조직조건교차,유대면적반흔자8례.근거자기제출적분형진행분형:Ⅰa형2례,Ⅰc형4례;Ⅱa형9례;Ⅲa형4례,Ⅲc형3례.근거기형형태선용피판이식、절골교형관절융합규정기형,회복력선.술후통과림상검사급X선편진행수방,림상평고채용동통시각모의평분(VAS)화미국족과외과협회(AOFAS)중족평분. 결과 소유환자술후획15 ～53개월(평균34.7개월)수방.말차수방시환자적VAS평분위0～6분,평균2.0분;AOFAS중족평분위73 ～ 94분,평균83.9분,우량솔위81.8％.1례환자술후3년행주시잉존재중족동통,기여환자회복량호,융합술후무골불련발생.결론 자기제출적분형유조우중족손상기형유합적수술치료,가획득만의료효.은정수상관절,회복족부력선화족궁시획득량호료효적관건.
Objective To characterize clinical treatment of the malunion after midfoot injury.Methods A retrospective study was carried out of the 22 cases of malunion following complex midfoot injury who had been admitted to our hospitals from June 2004 through June 2012.They were 19 men and 3 women,16 to 65 years of age (mean,37.8 years).There were 6 cases of Lisfranc joint injury 7 cases of Lisfranc joint complex injury combined with cuboid compression fracture and 9 cases of Lisfranc joint complex injury combined with navicular fracture.Eight patients presented with poor soft tissue and massive scar at the dorsal foot.The foot deformity was categorized into 3 types and 3 subtypes repectively,with type Ⅰ indicating normal foot arch (type Ⅰa forefoot abduction,type Ⅰb forefoot adduction and type Ⅰc normal forefoot),type Ⅱ Pes Cavus deformity (type Ⅱa combination with forefoot abduction,type Ⅱb combination with forefoot adduction,and type Ⅱc normal forefoot),and type Ⅲ flatfoot deformity (type Ⅲa combination with forefoot abduction,type Ⅲb combination with forefoot adduction,and type Ⅲc normal forefoot).There were 2 cases of type Ⅰa,4 cases of type Ⅰc,9 cases of type Ⅱa,4 cases of type Ⅲ a,and 3 cases of type Ⅲc in our cohort.According to the malunion typing,fascio-cutaneous flap,osteotomy,joint arthrodesis,or realignment was used to correct deformity.Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS)midfoot score and visual analogue scale (VAS).Results All the patients were followed up for an average of 34.7 months (range,from 15 to 53 months).The mean VAS score was 2.0 points (range,from 0 to 6 points) and the mean AOFAS score was 83.9 points (range,from 73 to 94 points) at the last follow-up,giving an excellent to good rate of 81.8％.All cases obtained favorable functional outcomes without bone nonunion,except for one patient who still suffered from midfoot walking discomfort 3 years after operation.Conclusions Operative management of malunion following midfoot injury is effective and good results can only be obtained by stabilizing the injured joint,realignment and restoring foot arch.Our typing of the midfoot malunion is helpful in the operative treatment.