Zhang Long-Jun, Chen Jian-Liang, Zheng Xiao-Dong, Xu Yong
Department of Orthopadics, the Shangyu Hospital of TCM, Shangyu 312300, Zhejiang, China.
Zhongguo Gu Shang. 2010 May;23(5):390-2.
To evaluate the therapy and the key points of the tarsometatarsal joint injury combined with metatarsal fracture.
From Jan. 2006 to Jul. 2008,19 patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury, 9 cases of tri-column injury. There were 8 cases of shaft fracture, 7 of neck fracture, 19 of foundation fracture.
All the incisions were first stage healed without skin necrosis. The healing time of fracture was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS, the average score was (84.500 +/- 8.553), the results were excellent in 4 cases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis.
No matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.
评估跗跖关节损伤合并跖骨骨折的治疗方法及要点。
2006年1月至2008年7月，对19例跗跖关节损伤合并跖骨骨折患者行切开复位克氏针或螺钉内固定治疗，其中男13例，女6例，平均年龄38.1岁（21～56岁）。跗跖关节损伤分型：内柱损伤2例，内、中柱损伤5例，外、中柱损伤3例，三柱损伤9例。跖骨骨折部位：骨干骨折8例，颈部骨折7例，基部骨折19例。
所有切口均一期愈合，无皮肤坏死。骨折愈合时间平均11.2周。所有患者随访6～17个月，平均12.8个月。根据AOFAS标准，平均评分为（84.500±8.553）分，优4例，良9例，可3例，差3例。6.4个月后恢复正常日常生活，3例患轻度骨关节炎。
无论采用何种固定方式，解剖复位对重建足弓、恢复足内、外侧纵弓最为重要。重建足弓保证了应力点支架的完整性，避免疼痛和跛行。跗跖关节及跖骨的解剖复位对重建足部功能也很重要。
