复杂中足损伤的临床治疗

目的 回顾复杂中足损伤的临床治疗,评价其临床治疗的特点及要点.方法 2003年6月至2008年6月问收治22例复杂中足损伤患者,其中开放性骨折8例,伴有软组织缺损者5例.急诊收治患者13例,另9例为外院已处理的患者.急诊患者中仅1例行舟骨和中间、外侧楔骨的关节融合,其余均行复位和内固定.转诊患者:2例行距舟关节融合,3例行Lisfranc关节融合伴1例行趾近节截除,1例行舟楔火节融合,1例行跗横火节融合,1例行内侧柱截除,1例行外侧柱重建.5例伴软组织缺损的患者,4例行游离前锯肌移植,1例行腓肠神绛伴行血管逆行岛状皮瓣移植修复.结果 全部患者术后随访5～44个月,平均17.5个月.急诊患者随访时的主要后遗症状为长时问行走后疼痛,2例患者经应用局部封闭及非甾体类镇痛药治疗后症状缓解.转诊患者中,2例行走时易疲劳、酸痛;2例外侧第4、5跖骨头跖侧胼胝伴疼痛;1例前、中、后足僵硬,同时存在足内肌较广泛的萎缩,有较重的行走疼痛;内侧柱截除的患者有足弓塌陷、后足外翻的表现,使用特制鞋行走.急诊收治患者AOFAS评分为(80.3±8.7)分,转诊患者为(60.1±16.3)分.结论 复杂的中足损伤应在允分了解功能解剖、创伤病理的基础上早期手术,解剖复位和牢靠同定是获得良好疗效的关键.

Clinical treatment of complex midfoot injury

Objective To evaluate the features and key points of clinical treatment of the complex midfoot injury retrospectively.Methods Twenty-two cases of complex midfoot injury were admitted to our hospital from June 2003 to June 2008, including 8 cases of open fracture and 5 cases of complicated soft tissue defects.Thirteen were emergency cases and the other 9 chronic ones were referred from other hospitals.In the emergency cases, only 1 underwent arthrodesis of the navicular and middle and lateral cuneiform and the others had reduction and internal fixation.In the referred cases, 2 received talar-navicular arthrodesis, 3 Lisfranc arthrndesis (accompanied by distal hallux amputation in 1), 1 navicular-cuneiform arthrudesis and 1 Chopart arthrndesis, 1 medial column amputation and 1 lateral column reconstruction.In the cases of soft tissue defects, 4 underwent free serratus anterior transfer, and 1 had transfer of distally-based sural fas-eio-cutaneous flap.The American Orthopaedic Foot & Ankle Society (AOFAS) scoring was used to evaluate the results.Results All the patients were followed up for 5 to 44 (average, 17.5) months.The main sequelae of the emergency cases were pain after long time waking, which was relieved following local injection of steroid and NIADs in 2 cases.Of the referred cases, pain and fatigue after walking were reported in 2, callus and pain under the 4th and 5th metatarsal heads in 2, and the whole foot rigidity and atrophy of the intrinsic muscle with severe pain while walking in 1.The case of medial column amputation developed medial arch collapse and valgus of hind foot.The mean AOFAS score for the emergency cases was 80.3± 8.7 and for the chronic ones was 60.1±16.3.Conclusion For complex midfoot injury, good results can only be obtained by early operation, anatomic reduction and stable fixation on the basis of enough understanding of the functional anatomy and traumatic pathology.