CAJ | 학술논문

背景:足舟骨骨折在临床上越来越常见,如果处理不当,极易影响患者负重行走以及行走步态.早期正确诊断和及时恰当的治疗对于防止足部并发症的发生极其重要.目的:探讨足舟骨骨折的手术治疗方法及疗效.方法:回顾性分析2002年7月至2012年3月,手术治疗且获得完整随访的90例(90足)足舟骨骨折患者的病例资料.男62例,女28例;年龄17~62岁,平均31.6岁;左足46例,右足44例.受伤原因:高处坠落伤38例,交通事故26例,扭伤18例,重物砸伤8例.入院后拍摄标准的足正、侧、斜位X线片及CT扫描.按照骨折部位分类:足舟骨背侧撕脱骨折6例,足舟骨结节撕脱骨折18例,足舟骨体部骨折66例.66例足舟骨体部骨折按照Sangeorzan骨折分型:Ⅰ型4例,Ⅱ型44例,Ⅲ型18例.受伤至手术时间为1~16 d,平均6.75 d.90例患者根据不同的骨折类型选择可吸收螺钉、空心螺钉、克氏针、钛板及外固定架固定手术治疗.术后定期复查拍摄X线片及CT扫描明确骨折愈合情况,记录足踝部功能恢复情况及相关并发症,按照美国足与踝关节协会(AOFAS)踝与中足评分标准评定治疗效果.结果:90例患者随访15~103个月,平均45.6个月.骨折愈合时间10~15周,平均12.1周.末次随访时AOFAS踝与中足评分平均为87.3分.4例患者出现螺钉断裂,但均未发生复位丢失.12例患者出现创伤性骨关节炎,后期随访未进行关节融合术.4例患者发生足舟骨缺血坏死,其中3例为足舟骨部分缺血坏死,发生距舟关节骨关节炎,行距舟关节及舟楔关节融合术;1例于术后5个月出现足舟骨全部坏死,继发扁平足,行三关节融合术.结论:不同类型的足舟骨骨折,选择合适的手术固定方式治疗可以取得良好的疗效.
배경:족주골골절재림상상월래월상견,여과처리불당,겁역영향환자부중행주이급행주보태.조기정학진단화급시흡당적치료대우방지족부병발증적발생겁기중요.목적:탐토족주골골절적수술치료방법급료효.방법:회고성분석2002년7월지2012년3월,수술치료차획득완정수방적90례(90족)족주골골절환자적병례자료.남62례,녀28례;년령17~62세,평균31.6세;좌족46례,우족44례.수상원인:고처추락상38례,교통사고26례,뉴상18례,중물잡상8례.입원후박섭표준적족정、측、사위X선편급CT소묘.안조골절부위분류:족주골배측시탈골절6례,족주골결절시탈골절18례,족주골체부골절66례.66례족주골체부골절안조Sangeorzan골절분형:Ⅰ형4례,Ⅱ형44례,Ⅲ형18례.수상지수술시간위1~16 d,평균6.75 d.90례환자근거불동적골절류형선택가흡수라정、공심라정、극씨침、태판급외고정가고정수술치료.술후정기복사박섭X선편급CT소묘명학골절유합정황,기록족과부공능회복정황급상관병발증,안조미국족여과관절협회(AOFAS)과여중족평분표준평정치료효과.결과:90례환자수방15~103개월,평균45.6개월.골절유합시간10~15주,평균12.1주.말차수방시AOFAS과여중족평분평균위87.3분.4례환자출현라정단렬,단균미발생복위주실.12례환자출현창상성골관절염,후기수방미진행관절융합술.4례환자발생족주골결혈배사,기중3례위족주골부분결혈배사,발생거주관절골관절염,행거주관절급주설관절융합술;1례우술후5개월출현족주골전부배사,계발편평족,행삼관절융합술.결론:불동류형적족주골골절,선택합괄적수술고정방식치료가이취득량호적료효.
Background:Tarsal navicular fractures are increasingly common in clinic. If these fractures are mishandled, it will be very likely to influence patients' gaits and weight-bearing walking. Thus early accurate diagnosis and appropriate treatment in time are of vital importance in the prevention of complications. Objective:To investigate surgical treatments of tarsal navicular fractures and its effectiveness. Methods:A retrospective study was undertaken in 90 tarsal navicular fractures patients (90 feet) treated surgically between July 2002 and March 2012. Their complete data of follow-up were obtained. There were 62 males and 28 females with a mean age of 31.6 years (range, 17-62 years). The left feet were involved in 46 cases and the right feet was in 44 cases. Inju-ries were caused by falling from height in 38 cases, by traffic accident in 26 cases, by sprain in 18 cases, and by heavy pound in 8 cases. X-ray and three-dimensional CT scanning were performed when the patients were admitted to our hospi-tal. There were 6 patients with dorsal avulsion fractures, 18 with tuberosity avulsion fracture, and 66 with body fractures. The body fractures were further classified according to the Sangeorzan system:typeⅠin 4 cases, typeⅡin 44 cases and typeⅢin 18 cases. The mean duration from injury to surgery was 6.75 d (range, 1-16 d). Different surgical treatments were selected for different types of 90 tarsal navicular fractures. Bone union was evaluated by X-ray and complications were re-corded. Final outcome was evaluated by the Ankle and Midfoot score system of American Orthopacdic Foot and Ankle Soci-ety (AOFAS).Results:All the patients were followed up for 45.6 months on average (range, 15-103 months). The mean time of bone union was 12.1 weeks (range, 10-15 weeks). The mean AOFAS score was 87.3 at the last follow-up. Screws broke in 4 pa-tients, but no reduction was lost. The traumatic osteoarthritis occurred in 12 patients and no further treatment, for example, arthrodesis was performed. Avascular necrosis of navicular bone occurred in 4 patients. Conclusions: Different surgical treatments can be selected for tarsal navicular fractures and satisfactory outcomes can be achieved.