小腿外伤后足趾屈曲畸形发生与疗效的相关因素分析

目的 统计不同小腿外伤致足趾屈曲畸形的发生率,探讨不同手术方式和手术时机对疗效的影响,及外伤后肌肉MRI表现与畸形发生的关系. 方法 1990年1月至2006年12月,采集小腿外伤病例1922例,502例患者于外伤后7～10 d行MRI检查.并发足趾屈曲畸形39例,男28例,女11例;年龄20～48岁,平均30.8岁.分别于畸形发生后3个月、3～6个月和6～18个月采用肌腱粘连松解及松解+肌腱延长两种方式矫正畸形.采用美国足与踝关节协会足趾关节功能评分法对矫正效果进行评定. 结果 39例全部得到随访,随访时间6～72个月(平均22个月),其中优18例,良15例,可4例,差2例,优良率84.62%.17例单纯行肌腱粘连松解术,复发2例;22例行松解+肌腱延长术,复发4例.畸形于6个月内矫正27例,复发5例,复发率18.52%;6个月以上矫正12例,复发1例,复发率8.33%.结论 本组小腿外伤后足趾屈曲畸形的发生率为2.03%,不同结构损伤,其发生率不同,以腓骨骨折最高,为3.38%.手术以单纯行肌腱粘连松解复发率为低.手术时机对预后有显著性影响,矫正手术宜在畸形发生后6个月以上进行.外伤后小腿<足母>长屈肌、趾长屈肌MRI信号的异常变化对足趾屈曲畸形发生的判断有一定的临床意义.

Incidence and therapeutic outcome of digital flexion deformity after leg injury

Objective To investigate the incidence and clinical characteristics of the digital flexion deformity after leg injury, as well as the therapeutic effects of different operative methods and timing for the deformity. Methods From January 1990 to December 2006, 1922 cases of leg injury were studied. Of them 39 cases had combined digital flexion deformity. They were 28 males and 11 females, with a mean age of 30. 8 (rang, 20 to 48) years old. The deformities were corrected by tendolysis alone or tendolysis plus tendon lengthening 3 months, 3 to 6 months, or 6 to 18 months after occurrence of deformity. MRI was performed 7 to 10 days after injury. The therapeutic effects were evaluated according to AOFAS (American Foot Ankle Society) interphalangeal scale. Results All the 39 cases were followed up for an average of 22 (6 to 72) months. Of them, 18 cases scored excellent, 15 good, 4 moderate, and 2 poor. The good to excellent rate was 84. 62%. Of the 17 cases corrected simply by tendolysis, 2 had recurrence of the deformity; of the 22 cases corrected by tendolysis plus lengthening, 4 had recurrence of the deformity; of the 27 cases corrected within 6 months, 5 ( 18.52% ) had recurrence of the deformity; of the 12 cases corrected 6months later, 1 (8. 33% ) had recurrence of the deformity. Conclusions The incidence in this series is 2.03%, varying from injury to injury. The fibular fracture has the highest rate of 3.38%. Simple tendolysis has the best therapeutic effect. The deformity should be corrected 6 or above months after the occurrence of the deformity. The abnormal MRI manifestations of the long hallux flexor and the long digital flexor are valuable for diagnosis of the digital flexion deformity after leg injury.