跖跗关节复合体损伤的手术治疗

目的 评价跖跗关节复合体损伤的手术治疗效果.方法 2003年1月至2008年12月,共收治167例闭合性跖跗关节损伤患者,其中跖跗关节复合体损伤35例.通过X线及CT检查明确诊断,闭合或切开复位螺钉或钢板内固定,术后定期放射学检查随访,以美国足踝外科协会(AOFAS)中足评分系统进行功能评估.结果 本组有135例获得12～78个月随访,平均随访时间48个月.其中跖跗关节复合体损伤26例,术后AOFAS评分48～75分,平均67分;其中16例继发创伤性关节炎,12例因疼痛明显、行走受限二期行关节融合术;单纯跖跗关节损伤109例,术后AOFAS评分70～95分,平均82分,继发创伤性关节炎的17例中5例二期行关节融合术.单纯跖跗关节损伤闭合复位经皮螺钉内固定者术后AOFAS中足评分82～95分,平均87分,与跖跗关节复合体损伤者比较差异具有统计学意义(t=2.651,P<0.05).结论 跖跗关节复合体损伤的预后比单纯跖跗关节损伤的差,而准确诊断、实现复合体各个部分的解剖复位和可靠固定是取得良好治疗效果的关键.

Surgical treatment of tarsometatarsal joint complex injury

Objective To report the outcome of surgical treatment of tarsometatarsal joint complex injury. Methods In the period from January 2003 to December 2008, 167 cases of closed tarsemetatarsal joint injury were treated, including 35 cases of tarsometatarsal joint complex injury. Diagnosis was made by X-ray examination or/and CT scan. Either dose or open reduction was performed and followed by internal fixation with screw or/and plate. X-ray examination was done in the regular follow-up and functional evaluation was carried out by AOFAS midfoot score system. Results In this series 135 cases got a mean follow-up of 48 months, ranging from 12 to 75 months. Therein the 26 cases of tarsometatareal joint complex injury had a mean postoperative AOFAS midfoot score of 67 ( ranging from 48 to 75 ), and secondary post-traumatic arthritis in 16 cases, 12 of which had arthrodesis as a result of severe pain. The 109 cases of pure tarsometatarsal joint injury had a mean postoperative AOFAS midfcot score of 82 ( ranging from 70 to 95 ), and secondary post-traumatic arthritis in 17 cases, only 5 of which had arthrodesis finally. Those cases of pure tarsometatarsal joint injury treated by close reduction and internal fixation with percutaneous screw got a mean postoperative AOFAS midfcot score of 87 (ranging from S2 to 95 ), demonstrating a significant deference ( t =2.651,P <0.05) when compared with that of metatarsal joint complex injury. Conclusion The tarsemetatarsal joint complex injury has a prognosis inferior to that of the pure tarsometatarsal joint injury, and the keys to its successful treatment are appropriate diagnosis, anatomical reduction and secure fixation of all the components of the complex.