可控加压骑缝钉联合自攻空心加压螺纹钉治疗跖跗关节损伤

目的 初步探讨可控加压骑缝钉联合钛合金自攻空心加压螺纹钉治疗跖跗关节损伤的临床疗效. 方法回顾性研究2006年3月至2007年12月应用可控加压骑缝钉联合钛合金自攻空心加压螺纹钉治疗跖跗关节损伤14例,其中单纯关节脱位4例,关节脱位伴骨折10例.按Myerson分类:A型2例,B型8例(B1型1例,B2型7例),C型4例;单纯内侧柱损伤2例,单纯中间柱损伤3例,内侧柱伴中间柱损伤2例,中间柱伴外侧柱损伤5例,三柱均损伤2例,2例患者同时伴有骰骨骨折.结果 所有切口均一期愈合,所有患者4周拆除石膏开始功能锻炼,术后12～16周拆除内固定后开始部分负重行走,拆除内固定物后22周开始完全负重行走.所有患者术后获得平均8.7个月(4～14个月)随访,根据美国足踝外科协会(AOFAS)评分平均为83.7分(75～91分). 结论可控加压骑缝钉联合自攻空心加压螺纹钉能灵活有效治疗跖跗关节复合体损伤,短期的临床随访获得令人满意的效果.

Uni-clip staples combined with titanium alloy Bold screws for treatment of tarsometatarsal joint in-juries

Objective To investigate the clinical effects of uni-clip staples combined with titanium alloy Bold screws for the treatment of tarsometatarsal joint injuries. Methods From June 2006 to De-cember 2007, 14 cases of tarsometatarsal joint injuries were treated with a combination of uni-clip staples and Bold screws, including 4 simple dislocations and 10 fracture-dislocations. According to Myerson's classifica-tion, 2 cases were of type A, 8 type B (1 type B1 and 7 type B2), and 4 type C. Injuries involved only medial column in 2 cases, middle column in 3, medial and middle columns in 2, middle and lateral columns in 5, and 3 columns in 2. In addition, 2 were combined with cuboid fractures. Results All the wounds healed primarily. At 4 weeks all the patients began functional exercise after removal of the plaster casts. At 12-16 weeks all the patients began to walk with partial weight loading after removal of the implants, and at 22 weeks they started to walk with full weight loading. The follow-ups lasted for an average of 8.7 (4 to 14) months. The American Orthopaedic Foot & Ankle Society (AOFAS) score averaged 83.7 (75 to 91). Conclusions As the Uni-clip staple can fix tarsometatarsal dislocations without damaging the articular surface, it can reduce the occurrence of osteoarthritis. More reliable than Kirschner wire, it is capable of elastic fixation of the lateral columns. It can also treat cuboid fractures with satisfactory results. In addition, Bold screws may allow automatic reduction and stable fixation of fractures in small wounds by compressive forces. It also protects the dorsal cortex of the metatarsal bone. A combined use of the two can lead to satisfactory results in the treatment of tarsometatarsal joint injuries.