复杂中足损伤分型治疗的初步探讨

背景：随着社会的发展，高能量损伤日渐增多，复杂中足损伤在临床并不鲜见。由于损伤涉及多个中足解剖结构，目前的治疗依然棘手。目的：回顾分析复杂中足损伤的三柱辅助关节分区的临床分型治疗，评价其临床分型与疗效关系并总结治疗要点。方法：2005年3月至2010年3月手术治疗复杂中足损伤患者20例，男12例，女8例，年龄21～59岁，平均32．5岁。均为闭合性损伤。按照三柱分型进行治疗，并区分损伤累及的跖跗关节、跗中关节、跗横关节，术后积极进行功能锻炼，并采用AOFAS中足评分系统对疗效进行评价。结果：20例患者均获得随访，随访时间12-36个月，平均20．2个月。手术切口愈合良好，未出现感染、骨不连、骨折畸形愈合等，也未发生接骨板螺钉松动、脱出、断裂及异物反应等与内植入物相关的并发症。术后6个月，2例患者行走时仍有足部不适感，1例发生轻度创伤性关节炎，长时间行走疼痛。根据AOFAS评分标准：优11例，良6例，可1例，差2例，优良率为85％。结论：三柱辅助关节分区分型方法可以有效指导复杂中足损伤的临床治疗，术中依次重建固定内侧柱、中间柱及外侧柱，并分别处理跖跗关节、跗中关节及跗横关节损伤。

Preliminary study of surgical treatment of complex midfoot injury based on clinical classification of injury

Background: High-energy injuries have been increasing with the development of our life. Complex midfoot injury is not rare in clinic. However, the treatment for this injury is still difficult as many anatomic structures of midfoot had been in- volved. Objective: The aim of the study is to evaluate the relationship between clinical classification and curative effect of complex midfoot injury and to summarize key points of treatment by using three-column theory combined with joint divisional theo- ry. Methods: Twenty patients with complex midfoot injury, who were treated by surgical treatment from March 2005 to March 2010 were enrolled in the retrospective study. There were 12 males and 8 females with an average age of 32.5 years (rang- ing from 21 to 59 years). All the patients are treated according to the three-column theory combined with joint divisional the- ory (Lisfranc joint, intertarsal joint and Chopart joint). Active functional exercises were done after operation. The clinical outcome was evaluated by AOFAS midfoot scoring. Results: All the patients were followed up and the mean duration was 20.2 months (range, 12 to 36 months). The operative incision healed well. No infection, nonunion and malunion of bone as well as complication of implant such as loosening, prolapse, breakage, foreign body reaction happened. Two patients felt discomfortable while walking and one had mild trau- matic arthritis at 6 months after the opeartion. According to AOFAS midfoot scoring, 11 cases were excellent, 6 cases were good, 1 case was fair, and 2 cases were bad; the rate of excellent and good was 85% Conclusions: Our injury classification--the three-column theory combined with joint divisional theory can provide signifi- cant guidance for the treatment of complex midfoot injury. The internal, medial, external columns need to be reconstructed and fixed firmly. The Lisfranc joint, intertarsal joint and Chopart joint also need to be handled, respectively.