Chen Jian-liang, Zhang Long-jun, Ye Feng, Zheng Xiao-dong, Wang Xiao, Xu Yong
Shangyu Hospital of Traditional Chinese Medicine, Shangyu, Zhejiang, China.
Zhongguo Gu Shang. 2011 Oct;24(10):869-72.
To explore the diagnosis and treatment of tarsometatarsal joint complex injury (TJC).
From January 2007 to January 2009,16 patients with tarsometatarsal joint complex injury were treated with open reduction and internal fixation. There were 12 males and 4 females, ranging in age from 21 to 45 years with an average of 34.1 years. Seven cases were left and 9 cases were right and all injuries caused by direct violence. Four cases caused by traffic accident 5 by fall from high and 7 by crush injury. Intercuneiform dislocation were in 11 cases, naviculocuneiform joint dislocation in 3 cases and cuboid fracture in 2 cases. All the cases were three column injuries. According to the situation of exploring and the stability, screw fixation was used for intertarsal joint, internal and middle column tarsometatarsal joint, the Kirschner wire fixation for external column and miniature plate fixation for comminuted fracture of metatarsal bones and compressible fracture of cuboid. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional scale was used to evaluate the clinical effect.
All the patients were followed up,the duration ranged from 6 to 18 months(averaged 12.6 months). According to the score system of AOFAS,the total score was (74.6+/-10.4 ) points, including pain items of (29.3+/-5.9), the score of functional items of (32.4+/-5.6) points, and power lines of (12.9+/-2.6). All the incisions were primarily healed without infection, skin necrosis,fixture broken or loosen. Three cases received arthrodesis due to osteoarthritis. Four cases were followed up continually because they only had the radiologic osteoarthritis without pain.
Anatomical reduction and stable fixation is the key point of the treatment of tarsometatarsal joint complex injury. Open reduction and internal fixation at the first stage is good for secondary arthrodesis.
探讨跗跖关节复合体损伤（TJC）的诊断与治疗方法。
2007年1月至2009年1月，对16例跗跖关节复合体损伤患者行切开复位内固定治疗。其中男12例，女4例；年龄21～45岁，平均34.1岁。左侧7例，右侧9例，均为直接暴力所致。交通事故伤4例，高处坠落伤5例，挤压伤7例。楔骨间关节脱位11例，舟楔关节脱位3例，骰骨骨折2例。均为三柱损伤。根据探查及稳定性情况，跗骨间关节、内中柱跗跖关节采用螺钉固定，外柱采用克氏针固定，跖骨粉碎性骨折及骰骨压缩性骨折采用微型钢板固定。采用美国足踝外科协会AOFAS足与踝关节手术评分系统评价临床疗效。
所有患者均获随访，随访时间6～18个月，平均12.6个月。根据AOFAS评分系统，总分（74.6±10.4）分，其中疼痛项（29.3±5.9）分，功能项评分（32.4±5.6）分，力线（12.9±2.6）分。所有切口均一期愈合，无感染、皮肤坏死、内固定断裂或松动。3例因创伤性关节炎行关节融合术。4例仅影像学有创伤性关节炎但无疼痛症状，继续随访观察。
解剖复位及稳定固定是跗跖关节复合体损伤治疗的关键。一期切开复位内固定有利于二期关节融合术。
