CAJ | 학술논문

背景：在跖跗关节骨折脱位以往的临床治疗过程中，采取的大多是闭合复位外固定的方式，但往往无法获得满意的修复效果，患者局部肿胀消退之后容易出现再移位的情况。因此，临床开始积极的利用切开复位内固定的方式对跖跗关节骨折脱位患者进行治疗，以恢复患足部功能，提高生活质量。目的：探讨跖跗关节骨折脱位行切开复位空心钉与克氏针置入内固定的临床效果。方法：从解放军八十八医院2012年9月至2013年9月收治的跖跗关节骨折脱位患者中随机选择42例进行研究，均实施切开复位空心钉与克氏针置入内固定治疗。治疗后随访患者的恢复情况，并利用美国足踝外科学会踝-后足评分量表对患者的踝-后足功能进行评定。结果与结论：入组的42例患者均获随访，随访时间1-12个月。经随访美国足踝外科学会踝-后足评分达到“好”的有30例，达到“较好”的有10例，评分为“差”的有2例，且此2例患者为受高能量损伤软组织情况较差者。37例患者在治疗后4-6个月即开始负重行走；3例患者存在轻微疼痛，以及一定的功能受限情况，可维持基本正常的行走步态；其余2例患者并发创伤性关节炎，无法正常负重行走。表明跖跗关节骨折脱位行切开复位空心钉与克氏针置入内固定可以达到良好的解剖复位效果，改善患者的足踝功能。
배경：재척부관절골절탈위이왕적림상치료과정중，채취적대다시폐합복위외고정적방식，단왕왕무법획득만의적수복효과，환자국부종창소퇴지후용역출현재이위적정황。인차，림상개시적겁적이용절개복위내고정적방식대척부관절골절탈위환자진행치료，이회복환족부공능，제고생활질량。목적：탐토척부관절골절탈위행절개복위공심정여극씨침치입내고정적림상효과。방법：종해방군팔십팔의원2012년9월지2013년9월수치적척부관절골절탈위환자중수궤선택42례진행연구，균실시절개복위공심정여극씨침치입내고정치료。치료후수방환자적회복정황，병이용미국족과외과학회과-후족평분량표대환자적과-후족공능진행평정。결과여결론：입조적42례환자균획수방，수방시간1-12개월。경수방미국족과외과학회과-후족평분체도“호”적유30례，체도“교호”적유10례，평분위“차”적유2례，차차2례환자위수고능량손상연조직정황교차자。37례환자재치료후4-6개월즉개시부중행주；3례환자존재경미동통，이급일정적공능수한정황，가유지기본정상적행주보태；기여2례환자병발창상성관절염，무법정상부중행주。표명척부관절골절탈위행절개복위공심정여극씨침치입내고정가이체도량호적해부복위효과，개선환자적족과공능。
BACKGROUND:Closed reduction and internal fixation are mostly used to treat fracture dislocation of tarsometatarsal joint, but cannot obtain satisfactory repair effect. Redisplacement easily appeared after local sweling subsidence. Therefore, open reduction and internal fixation are actively used in the clinic to treat fracture dislocation of tarsometatarsal joint so as to restore foot function and to elevate quality of life. OBJECTIVE:To explore the clinical effect of open reduction and cannulated screw and Kirschner wire fixation for fracture dislocation of tarsometatarsal joint. METHODS:A total of 42 patients with fracture dislocation of tarsometatarsal joint in the 88 Hospital of Chinese PLA from September 2012 to September 2013 were selected and were given open reduction and cannulated screw and Kirschner wire fixation. After treatment, the recovery of patients was observed, and ankle hindfoot function was assessed with American Orthopaedic Foot and Ankle Society ankle hindfoot score. RESULTS AND CONCLUSION:A total of 42 patients were folowed up for 1-12 months. American Orthopaedic Foot and Ankle Society ankle hindfoot score results showed that there were excelent in 30 cases, good in 10 cases, and poor in 2 cases, and the 2 patients were subjected to high energy soft tissue injury. 37 patients in 4-6 months after operation started weight-bearing walking. Three patients had mild pain, a certain functional limitation, but could maintain normal walking gait. The remaining two patients complicated with traumatic arthritis, and were unable to do normal weight-bearing walking. These results show that open reduction and cannulated screw and Kirschner wire fixation can achieve good effect of anatomical reduction of fracture dislocation of tarsometatarsal joint, and improve patient’s ankle function.