中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
9期
737-740
,共4页
足损伤%骨折%脱位%外固定器
足損傷%骨摺%脫位%外固定器
족손상%골절%탈위%외고정기
Foot injuries%Fractures,bone%Dislocation%External fixators
目的 探讨微型双边外固定支架结合有限内固定治疗严重中足骨折脱位的临床疗效.方法 对2009年5月至2012年8月收治的8例严重中足骨折脱位患者资料进行回顾性分析,男6例,女2例;年龄28 ～57岁,平均35.4岁.开放性损伤按Gustilo分型:Ⅱ型1例,Ⅲ型7例;中足骨折合并跗横关节脱位2例,跖跗关节脱位4例,跗横关节与跖跗关节均脱位2例.对骨折与脱位进行复位后,以微型双边外固定支架进行固定,恢复并保持足的内、外侧柱长度及正常足弓形态,必要时可结合有限内固定.术后12 ～16周拆除外固定支架,采用美国足踝外科协会(AOFAS)中足评分和疼痛视觉模拟评分(VAS)评估临床疗效. 结果 所有患者术后获10 ～24个月(平均13.4个月)随访.术后X线片示骨折脱位均获得良好复位,内、外固定拆除后无复位丢失.患者均能自主行走,随访期间未出现创伤性关节炎及足部畸形.术后3、6、12个月AOFAS中足评分平均分别为65.8、71.3、80.6分,术后3、6、12个月VAS评分平均分别为7.5、4.3、1.2分. 结论 对于严重中足骨折脱位,微型双边外固定支架结合有限内固定能很好地恢复内、外侧柱的长度及足弓的正常形态,维持复位稳定性,避免了足部畸形导致的功能障碍.
目的 探討微型雙邊外固定支架結閤有限內固定治療嚴重中足骨摺脫位的臨床療效.方法 對2009年5月至2012年8月收治的8例嚴重中足骨摺脫位患者資料進行迴顧性分析,男6例,女2例;年齡28 ～57歲,平均35.4歲.開放性損傷按Gustilo分型:Ⅱ型1例,Ⅲ型7例;中足骨摺閤併跗橫關節脫位2例,蹠跗關節脫位4例,跗橫關節與蹠跗關節均脫位2例.對骨摺與脫位進行複位後,以微型雙邊外固定支架進行固定,恢複併保持足的內、外側柱長度及正常足弓形態,必要時可結閤有限內固定.術後12 ～16週拆除外固定支架,採用美國足踝外科協會(AOFAS)中足評分和疼痛視覺模擬評分(VAS)評估臨床療效. 結果 所有患者術後穫10 ～24箇月(平均13.4箇月)隨訪.術後X線片示骨摺脫位均穫得良好複位,內、外固定拆除後無複位丟失.患者均能自主行走,隨訪期間未齣現創傷性關節炎及足部畸形.術後3、6、12箇月AOFAS中足評分平均分彆為65.8、71.3、80.6分,術後3、6、12箇月VAS評分平均分彆為7.5、4.3、1.2分. 結論 對于嚴重中足骨摺脫位,微型雙邊外固定支架結閤有限內固定能很好地恢複內、外側柱的長度及足弓的正常形態,維持複位穩定性,避免瞭足部畸形導緻的功能障礙.
목적 탐토미형쌍변외고정지가결합유한내고정치료엄중중족골절탈위적림상료효.방법 대2009년5월지2012년8월수치적8례엄중중족골절탈위환자자료진행회고성분석,남6례,녀2례;년령28 ～57세,평균35.4세.개방성손상안Gustilo분형:Ⅱ형1례,Ⅲ형7례;중족골절합병부횡관절탈위2례,척부관절탈위4례,부횡관절여척부관절균탈위2례.대골절여탈위진행복위후,이미형쌍변외고정지가진행고정,회복병보지족적내、외측주장도급정상족궁형태,필요시가결합유한내고정.술후12 ～16주탁제외고정지가,채용미국족과외과협회(AOFAS)중족평분화동통시각모의평분(VAS)평고림상료효. 결과 소유환자술후획10 ～24개월(평균13.4개월)수방.술후X선편시골절탈위균획득량호복위,내、외고정탁제후무복위주실.환자균능자주행주,수방기간미출현창상성관절염급족부기형.술후3、6、12개월AOFAS중족평분평균분별위65.8、71.3、80.6분,술후3、6、12개월VAS평분평균분별위7.5、4.3、1.2분. 결론 대우엄중중족골절탈위,미형쌍변외고정지가결합유한내고정능흔호지회복내、외측주적장도급족궁적정상형태,유지복위은정성,피면료족부기형도치적공능장애.
Objective To evaluate the clinical efficacy of external biplanar mini-fixator and limited internal fixation in treatment of severe midfoot fracture-dislocation.Methods Eight patients with severe midfoot fracture-dislocation were admitted from May 2009 to August 2012.They were 6 men and 2 women,28 to 57 years of age (average,35.4 years).According to the Gustilo classification,there were one type Ⅱand 7 cases of type Ⅲ.Two cases of midfoot fracture were complicated with dislocation of the transverse tarsal joint,4 with dislocation of the tarsometatarsal joint,and 2 with dislocation of both the transverse tarsal joint and the tarsometatarsal joint.The external biplanar mini-fixator was applied to stabilize and maintain lengths of the medial and lateral columns and normal geometry of the foot arch after reduction of the fracture-dislocation.K-wires were used if limited internal fixation was necessary.The external fixator was removed at 12 to 16 weeks postoperatively.The clinical treatment efficacy was assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale and the visual analogue scale (VAS).Results The patients were followed up for an average of 13.4 months (from 10 to 24 months).Postoperative radiological films showed fine reduction of the fractures and dislocations.No reduction was lost after removal of external and internal fixations.They were able to walk independently and had good functional recovery of the injured feet without traumatic arthritis during the follow-up period.Their average AOFAS scores were 65.8 at 3 months after operation,71.3 at 6 months and 80.6 at 12 months; the average VAS scores were 7.5 at 3 months,4.3 at 6 months,and 1.2 at 12 months,respectively.Conclusion In treatment of severe midfoot fracture-dislocation,external biplanar mini-fixator combined with limited internal fixation can perfectly reconstruct and maintain the medial and lateral columns and normal geometry of the foot arch,preventing functional disability caused by foot malformation.
