微型外固定支架结合有限内固定治疗跗横关节骨折脱位

目的 分析微型外固定支架结合有限内固定治疗跗横关节骨折脱位的临床疗效.方法 自2006年5月至2008年1月应用微型外固定支架结合有限内同定治疗跗横关节骨折脱位15例,骨折脱佗按Main分型:Ⅰ型8例,Ⅱ型2例,Ⅳ型1例,Ⅴ型4例.对骨折脱位行切开复位内同定,使用微型外固定支架恢复维持足内外侧柱的长度.术后指导功能锻炼,术后3个月拆除内、外固定,采用美国足踝外科协会(AOFAS)中足评分系统评估临床疗效. 结果 本组12例患者获得11～24个月(平均15个月)随访,3例失访.术后3个月AOFAS评分为(68.6±3.9)分,术后6个月为(72.9±2.6)分,术后1年为(77.5±4.6)分,所有患者均能自丰行走,无需进一步治疗. 结论 微型外固定支架结合有限内固定治疗跗横关节骨折脱位可获得满意的临床疗效,治疗时除了使骨折脱位解剖复位外,更应注意恢复足内外侧柱的长度.

Treatment of Chopart joint fracture-dislocation with external mini-fixator and limited internal fixation

Objective To evaluate the clinical treatment of Chopart fracture-dislocation with external mini-fixator and limited internal fixation. Methods From May 2006 to January 2008, 15 feet with Chopart fracture-dislocation were treated with external mini-fixator and limited internal fixation. The frac-ture-dislocation was treated with open reduction and internal fixation while the lengths of the medial and lateral columns of the foot were maintained by external mini-fixator. Functional exercises were encouraged under the doctors' instructions and regular follow-ups were carried out with X-ray examination. Three months after op-eration the fixation devices and implants were removed to evaluate the clinical results with the American Or-thopaedic Foot & Ankle Society(AOFAS) for the midfoot. Results Three patients were lost to the fol-low-up and the others were followed up for an average of 15 (11 to 24) months. Their average AOFAS scores were 68.6±3.9 at 3 months after surgery, 72.9±2.6 at 6 months, and 77.5±4.6 at 12 months. All of them were capable of independent walking with no need for further treatment. Conclusions External mini-fixation combined with limited internal fixation is an effective treatment for Chopart fracture-dislocation. Besides the anatomical reduction of the fracture-dislocation, special attention should be paid to restoring lengths of the medial and lateral columns of the foot.