可吸收棒髓内固定治疗跖骨不稳定骨折

背景：与传统金属固定物比较，可吸收材料在治疗四肢非负重骨骨折中具有独特优势。 目的：介绍应用可吸收棒髓内固定治疗跖骨不稳定骨折的经验和技术要点。 方法：采用切开复位可吸收棒髓内固定的方法，对45例不稳定跖骨骨折进行治疗，男36例，女9例；年龄19~62岁，平均36.6岁。单根跖骨骨折17例，多发骨折28例，共104处骨折，其中第1跖骨15处，第2、3、4跖骨77处，第5跖骨12处。患者术前均摄足正侧斜位X射线片检查。术中通过跖骨背侧切口，直视下复位骨折端，经骨折端和跖骨头用钻头钻孔，经孔道向髓腔内放置长度合适可吸收棒。 结果与结论：所有患者获得4~36个月，平均18.4个月随访。术后均未发生切口感染、内固定断裂及骨折移位等并发症，4例出现迟发性切口周围炎症反应。术后平均骨折愈合时间为10周。X射线片检查示跖骨外形基本恢复正常。按美国足踝外科协会(AOFAS)前足评分系统，优35例，良10例，优良率100%。结果提示可吸收棒髓内固定可用于治疗跖骨不稳定骨折，具有操作简单、并发症少、疗效好等优点。 关键词：可吸收棒；骨折固定术，髓内；随访研究；跖骨骨折；可吸收材料 doi:10.3969/j.issn.1673-8225.2010.25.029

Intramedullary fixation of absorbable implants for unstable metatarsal fractures

BACKGROUND: Compared with traditional metal fixity, absorbing material shows distinctive advantages in treatment of fracture of non-weight bearing bone of limbs. OBJECTIVE: To introduce the experience and key points of intramedullary absorbable implants in the treatment of displaced metatarsal fractures. METHODS: Open reduction and internal fixation with intramedullary absorbable implants were performed in 45 cases with displaced metatarsal fractures including 36 males and 9 females, with an average age of 36.6 years (19-62 years). A total of 104 fractures included 17 simple metatarsal fractures and 28 multiple fractures. There were 15 fractures in the first metatarsal, 77 in the second to fourth metatarsal and 12 in the fifth metatarsal. All patients underwent radiography of anteroposterior, lateral and oblique views for foot. All fractures were reduced from dorsal approach and drill was used to perforate through fracture end and metatarsal fracture head for the placement of absorbable implants with appropriate length. RESULTS AND CONCLUSION: All patients were followed up for an average of 18.4 months (ranged from 4 to 36 months). No complications such as wound infection, implants breakage and displacement fracture were found postoperatively. The tardive inflammatory reactions surrounding incisions were observed in 4 cases. The average time for bone healing was 10 weeks. Radiography showed basic restoration of metatarsal shape. The results were excellent in 35 cases, good in 10 cases according to the American Orthopaedic Foot and Ankle Society forefoot score, with excellent and good rate of 100%. Results indicated that the displaced metatarsal fractures could be treated by intramedullary absorbable implants, with advantages of simple procedures, few complications and good clinical results.